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l 113.158 665.197 l 115.626 661.36 l 116.364 661.36 l 116.364 666.109 l 115.728 666.109 l 115.728 662.272 l f* 119.947 662.742 m 120.427 661.359 l 121.145 661.359 l 119.386 666.109 l 118.643 666.109 l 116.817 661.359 l 117.493 661.359 l 118 662.742 l 119.947 662.742 l h 118.204 663.311 m 118.98 665.402 l 118.994 665.402 l 119.711 663.311 l 118.204 663.311 l f* 120.373 665.54 m 122.017 665.54 l 122.017 661.359 l 122.673 661.359 l 122.673 665.54 l 124.316 665.54 l 124.316 666.109 l 120.373 666.109 l 120.373 665.54 l f* 124.898 666.109 0.655 -4.75 re f 130.423 663.734 m 130.423 662.617 129.787 661.804 128.732 661.804 c 127.678 661.804 127.042 662.617 127.042 663.734 c 127.042 664.852 127.678 665.666 128.732 665.666 c 129.787 665.666 130.423 664.852 130.423 663.734 c h 131.098 663.734 m 131.098 664.76 130.544 666.235 128.732 666.235 c 126.92 666.235 126.365 664.76 126.365 663.734 c 126.365 662.709 126.92 661.233 128.732 661.233 c 130.544 661.233 131.098 662.709 131.098 663.734 c f* 134.933 662.272 m 134.919 662.272 l 132.492 666.109 l 131.714 666.109 l 131.714 661.36 l 132.35 661.36 l 132.35 665.197 l 132.363 665.197 l 134.832 661.36 l 135.569 661.36 l 135.569 666.109 l 134.933 666.109 l 134.933 662.272 l f* 139.153 662.742 m 139.633 661.359 l 140.351 661.359 l 138.592 666.109 l 137.848 666.109 l 136.022 661.359 l 136.699 661.359 l 137.205 662.742 l 139.153 662.742 l h 137.409 663.311 m 138.186 665.402 l 138.199 665.402 l 138.917 663.311 l 137.409 663.311 l f* 141.466 666.109 m 140.81 666.109 l 140.81 661.36 l 143.927 661.36 l 143.927 661.929 l 141.466 661.929 l 141.466 666.109 l f* 107.786 656.725 m 107.691 657.519 107.041 658.28 105.79 658.28 c 104.377 658.28 103.525 657.268 103.525 655.806 c 103.525 653.98 104.607 653.278 105.71 653.278 c 106.074 653.278 107.562 653.357 107.833 655.151 c 107.197 655.151 l 106.974 654.047 106.237 653.848 105.811 653.848 c 104.607 653.848 104.202 654.708 104.202 655.826 c 104.202 657.076 104.912 657.711 105.79 657.711 c 106.257 657.711 106.967 657.559 107.15 656.725 c 107.786 656.725 l f* 109.206 655.442 m 110.795 655.442 l 111.579 655.442 111.661 654.986 111.661 654.595 c 111.661 654.417 111.681 653.696 111.776 653.404 c 112.579 653.404 l 112.579 653.51 l 112.377 653.623 112.344 653.723 112.336 653.986 c 112.296 654.847 l 112.268 655.508 111.992 655.627 111.714 655.74 c 112.025 655.919 112.39 656.177 112.39 656.877 c 112.39 657.883 111.593 658.154 110.795 658.154 c 108.55 658.154 l 108.55 653.404 l 109.206 653.404 l 109.206 655.442 l h 109.206 657.605 m 110.842 657.605 l 111.167 657.605 111.714 657.546 111.714 656.811 c 111.714 656.111 111.207 655.991 110.727 655.991 c 109.206 655.991 l 109.206 657.605 l f* 113.297 658.153 0.656 -4.75 re f 114.595 657.585 m 116.239 657.585 l 116.239 653.404 l 116.894 653.404 l 116.894 657.585 l 118.538 657.585 l 118.538 658.154 l 114.595 658.154 l 114.595 657.585 l f* 119.12 658.153 0.656 -4.75 re f 124.881 656.725 m 124.787 657.519 124.137 658.28 122.886 658.28 c 121.473 658.28 120.62 657.268 120.62 655.806 c 120.62 653.98 121.702 653.278 122.805 653.278 c 123.17 653.278 124.658 653.357 124.929 655.151 c 124.293 655.151 l 124.069 654.047 123.332 653.848 122.906 653.848 c 121.702 653.848 121.297 654.708 121.297 655.826 c 121.297 657.076 122.007 657.711 122.886 657.711 c 123.353 657.711 124.063 657.559 124.245 656.725 c 124.881 656.725 l f* 128.276 654.787 m 128.755 653.404 l 129.472 653.404 l 127.715 658.154 l 126.97 658.154 l 125.145 653.404 l 125.82 653.404 l 126.328 654.787 l 128.276 654.787 l h 126.531 655.356 m 127.308 657.446 l 127.322 657.446 l 128.039 655.356 l 126.531 655.356 l f* 130.589 658.154 m 129.932 658.154 l 129.932 653.404 l 133.05 653.404 l 133.05 653.973 l 130.589 653.973 l 130.589 658.154 l f* 103.302 650.199 0.656 -4.751 re f 108.239 646.362 m 108.225 646.362 l 105.797 650.199 l 105.019 650.199 l 105.019 645.45 l 105.655 645.45 l 105.655 649.287 l 105.669 649.287 l 108.137 645.45 l 108.874 645.45 l 108.874 650.199 l 108.239 650.199 l 108.239 646.362 l f* 113.791 648.77 m 113.696 649.564 113.046 650.325 111.796 650.325 c 110.383 650.325 109.531 649.313 109.531 647.851 c 109.531 646.025 110.612 645.323 111.714 645.323 c 112.079 645.323 113.568 645.403 113.838 647.196 c 113.202 647.196 l 112.979 646.091 112.242 645.893 111.816 645.893 c 110.612 645.893 110.206 646.753 110.206 647.87 c 110.206 649.121 110.916 649.756 111.796 649.756 c 112.262 649.756 112.972 649.604 113.155 648.77 c 113.791 648.77 l f* 114.575 650.199 0.656 -4.751 re f 116.326 645.45 m 118.268 645.45 l 119.863 645.45 120.336 646.825 120.336 647.891 c 120.336 649.26 119.559 650.199 118.295 650.199 c 116.326 650.199 l 116.326 645.45 l h 116.982 649.651 m 118.206 649.651 l 119.099 649.651 119.661 649.048 119.661 647.851 c 119.661 646.654 119.106 645.999 118.254 645.999 c 116.982 645.999 l 116.982 649.651 l f* 124.671 646.019 m 121.743 646.019 l 121.743 647.606 l 124.401 647.606 l 124.401 648.175 l 121.743 648.175 l 121.743 649.63 l 124.624 649.63 l 124.624 650.199 l 121.087 650.199 l 121.087 645.45 l 124.671 645.45 l 124.671 646.019 l f* 128.607 646.362 m 128.594 646.362 l 126.166 650.199 l 125.388 650.199 l 125.388 645.45 l 126.024 645.45 l 126.024 649.287 l 126.038 649.287 l 128.506 645.45 l 129.242 645.45 l 129.242 650.199 l 128.607 650.199 l 128.607 646.362 l f* 129.696 649.63 m 131.339 649.63 l 131.339 645.448 l 131.995 645.448 l 131.995 649.63 l 133.639 649.63 l 133.639 650.199 l 129.696 650.199 l 129.696 649.63 l f* 109.101 640.855 m 109.074 641.378 108.904 642.37 107.207 642.37 c 106.031 642.37 105.537 641.642 105.537 640.902 c 105.537 640.075 106.254 639.857 106.571 639.783 c 107.566 639.559 l 108.363 639.373 108.6 639.214 108.6 638.719 c 108.6 638.038 107.803 637.918 107.329 637.918 c 106.706 637.918 105.99 638.169 105.99 639.03 c 105.375 639.03 l 105.375 638.586 105.455 638.19 105.868 637.826 c 106.085 637.634 106.436 637.368 107.336 637.368 c 108.167 637.368 109.235 637.68 109.235 638.804 c 109.235 639.559 108.762 639.929 108.134 640.075 c 106.747 640.386 l 106.463 640.452 106.173 640.584 106.173 640.988 c 106.173 641.708 106.869 641.82 107.281 641.82 c 107.829 641.82 108.451 641.589 108.485 640.855 c 109.101 640.855 l f* 109.506 641.675 m 111.149 641.675 l 111.149 637.494 l 111.805 637.494 l 111.805 641.675 l 113.449 641.675 l 113.449 642.244 l 109.506 642.244 l 109.506 641.675 l f* 114.666 639.532 m 116.256 639.532 l 117.04 639.532 117.121 639.076 117.121 638.685 c 117.121 638.507 117.141 637.786 117.236 637.495 c 118.04 637.495 l 118.04 637.6 l 117.838 637.713 117.804 637.812 117.796 638.077 c 117.756 638.937 l 117.729 639.599 117.452 639.717 117.175 639.83 c 117.485 640.009 117.851 640.267 117.851 640.967 c 117.851 641.973 117.054 642.244 116.256 642.244 c 114.01 642.244 l 114.01 637.495 l 114.666 637.495 l 114.666 639.532 l h 114.666 641.695 m 116.303 641.695 l 116.628 641.695 117.175 641.636 117.175 640.902 c 117.175 640.2 116.668 640.081 116.188 640.081 c 114.666 640.081 l 114.666 641.695 l f* 122.308 638.064 m 119.379 638.064 l 119.379 639.651 l 122.038 639.651 l 122.038 640.22 l 119.379 640.22 l 119.379 641.675 l 122.26 641.675 l 122.26 642.244 l 118.723 642.244 l 118.723 637.495 l 122.308 637.495 l 122.308 638.064 l f* 126.568 640.855 m 126.541 641.378 126.372 642.37 124.675 642.37 c 123.498 642.37 123.005 641.642 123.005 640.902 c 123.005 640.075 123.721 639.857 124.039 639.783 c 125.033 639.559 l 125.832 639.373 126.067 639.214 126.067 638.719 c 126.067 638.038 125.27 637.918 124.797 637.918 c 124.174 637.918 123.457 638.169 123.457 639.03 c 122.842 639.03 l 122.842 638.586 122.923 638.19 123.335 637.826 c 123.552 637.634 123.904 637.368 124.803 637.368 c 125.635 637.368 126.703 637.68 126.703 638.804 c 126.703 639.559 126.23 639.929 125.601 640.075 c 124.215 640.386 l 123.931 640.452 123.639 640.584 123.639 640.988 c 123.639 641.708 124.337 641.82 124.748 641.82 c 125.297 641.82 125.919 641.589 125.952 640.855 c 126.568 640.855 l f* 130.937 640.855 m 130.91 641.378 130.74 642.37 129.043 642.37 c 127.867 642.37 127.373 641.642 127.373 640.902 c 127.373 640.075 128.09 639.857 128.408 639.783 c 129.402 639.559 l 130.2 639.373 130.436 639.214 130.436 638.719 c 130.436 638.038 129.639 637.918 129.165 637.918 c 128.542 637.918 127.826 638.169 127.826 639.03 c 127.211 639.03 l 127.211 638.586 127.292 638.19 127.704 637.826 c 127.921 637.634 128.272 637.368 129.172 637.368 c 130.003 637.368 131.072 637.68 131.072 638.804 c 131.072 639.559 130.598 639.929 129.97 640.075 c 128.583 640.386 l 128.299 640.452 128.009 640.584 128.009 640.988 c 128.009 641.708 128.706 641.82 129.118 641.82 c 129.665 641.82 130.287 641.589 130.322 640.855 c 130.937 640.855 l f* 98.274 631.696 m 100.654 631.696 l 100.654 632.265 l 98.274 632.265 l 98.274 633.72 l 100.979 633.72 l 100.979 634.289 l 97.618 634.289 l 97.618 629.538 l 98.274 629.538 l 98.274 631.696 l f* 105.361 631.914 m 105.361 630.797 104.725 629.983 103.671 629.983 c 102.615 629.983 101.98 630.797 101.98 631.914 c 101.98 633.032 102.615 633.846 103.671 633.846 c 104.725 633.846 105.361 633.032 105.361 631.914 c h 106.037 631.914 m 106.037 632.94 105.482 634.415 103.671 634.415 c 101.858 634.415 101.303 632.94 101.303 631.914 c 101.303 630.89 101.858 629.413 103.671 629.413 c 105.482 629.413 106.037 630.89 106.037 631.914 c f* 109.838 634.289 m 109.838 631.286 l 109.838 630.254 109.161 629.983 108.56 629.983 c 107.971 629.983 107.329 630.268 107.329 631.3 c 107.329 634.289 l 106.673 634.289 l 106.673 631.121 l 106.673 630.234 107.235 629.413 108.539 629.413 c 109.871 629.413 110.494 630.234 110.494 631.207 c 110.494 634.289 l 109.838 634.289 l f* 114.598 630.453 m 114.585 630.453 l 112.157 634.289 l 111.379 634.289 l 111.379 629.54 l 112.015 629.54 l 112.015 633.377 l 112.029 633.377 l 114.497 629.54 l 115.235 629.54 l 115.235 634.289 l 114.598 634.289 l 114.598 630.453 l f* 116.14 629.54 m 118.081 629.54 l 119.677 629.54 120.151 630.916 120.151 631.981 c 120.151 633.35 119.373 634.289 118.108 634.289 c 116.14 634.289 l 116.14 629.54 l h 116.797 633.741 m 118.02 633.741 l 118.913 633.741 119.474 633.138 119.474 631.941 c 119.474 630.744 118.919 630.089 118.068 630.089 c 116.797 630.089 l 116.797 633.741 l f* 123.275 630.922 m 123.754 629.538 l 124.472 629.538 l 122.713 634.289 l 121.97 634.289 l 120.143 629.538 l 120.82 629.538 l 121.328 630.922 l 123.275 630.922 l h 121.53 631.491 m 122.308 633.581 l 122.322 633.581 l 123.038 631.491 l 121.53 631.491 l f* 123.701 633.72 m 125.344 633.72 l 125.344 629.538 l 126 629.538 l 126 633.72 l 127.643 633.72 l 127.643 634.289 l 123.701 634.289 l 123.701 633.72 l f* 128.225 634.289 0.655 -4.751 re f 133.75 631.914 m 133.75 630.797 133.114 629.983 132.059 629.983 c 131.005 629.983 130.368 630.797 130.368 631.914 c 130.368 633.032 131.005 633.846 132.059 633.846 c 133.114 633.846 133.75 633.032 133.75 631.914 c h 134.426 631.914 m 134.426 632.94 133.872 634.415 132.059 634.415 c 130.246 634.415 129.692 632.94 129.692 631.914 c 129.692 630.89 130.246 629.413 132.059 629.413 c 133.872 629.413 134.426 630.89 134.426 631.914 c f* 138.26 630.453 m 138.247 630.453 l 135.82 634.289 l 135.041 634.289 l 135.041 629.54 l 135.678 629.54 l 135.678 633.377 l 135.691 633.377 l 138.158 629.54 l 138.896 629.54 l 138.896 634.289 l 138.26 634.289 l 138.26 630.453 l f* q 1.0111 0 0 0.989 0 0 cm 0.137 0.122 0.125 RG 0.281 w 2.613 M 115.138 706.081 m 118.546 706.081 l 118.544 702.586 l 121.365 704.426 l 122.991 701.778 l 119.973 700.02 l 123.013 698.297 l 121.45 695.584 l 118.524 697.28 l 118.524 693.713 l 115.151 693.713 l 115.15 697.201 l 112.165 695.481 l 110.602 698.315 l 113.554 699.996 l 110.546 701.757 l 112.106 704.39 l 115.138 702.585 l 115.138 706.081 l b* Q 1 1 1 rg 118.527 696.813 m 118.117 697.519 117.761 696.804 y 118.106 687.761 l 118.236 687.508 118.291 687.786 y 118.527 696.813 l f* q 1.0111 0 0 0.989 0 0 cm 0.137 0.122 0.125 RG 0.14 w 2.613 M 116.575 701.63 m 116.344 701.774 116.235 701.899 y 115.648 702.526 115.637 703.008 y 115.62 703.429 115.767 703.671 y 115.886 703.932 116.26 704.069 y 116.482 704.156 116.512 704.133 y 116.806 704.128 116.95 703.891 y 117.428 703.549 116.806 703.559 y 116.511 703.603 116.425 703.668 y 116.058 703.569 116.131 703.028 y 116.204 702.706 116.399 702.354 116.553 702.275 c 116.575 701.63 l b* Q q 1.0111 0 0 0.989 0 0 cm 1 1 1 RG 0.14 w 2.613 M 116.805 703.868 m 116.757 703.875 116.706 703.853 116.662 703.875 c 116.643 703.886 116.634 703.911 116.642 703.927 c 116.647 703.94 116.68 703.963 116.701 703.954 c 116.746 703.938 116.758 703.882 116.805 703.868 c b* Q q 1.0111 0 0 0.989 0 0 cm 0.137 0.122 0.125 RG 0.14 w 2.613 M 116.774 697.231 m 116.803 697.4 116.884 697.528 v 116.954 697.639 117.014 697.697 117.131 697.821 c 117.196 697.889 117.287 698.017 117.353 698.096 c 117.579 698.381 117.391 698.688 v 117.304 698.818 117.071 699.022 v 117.076 698.396 l 117.073 698.249 116.675 697.796 y 116.576 697.67 116.526 697.61 116.478 697.252 c 116.44 696.842 116.776 696.404 v 116.756 697.064 l 116.761 697.177 116.774 697.231 v b* Q q 1.0111 0 0 0.989 0 0 cm 0.137 0.122 0.125 RG 0.14 w 2.613 M 117.14 701.235 m 117.175 701.129 116.625 700.553 y 116.577 700.497 116.521 700.435 116.458 700.366 c 116.113 699.991 116.13 699.682 v 116.148 699.251 116.569 698.845 v 116.622 698.803 116.693 698.726 v 116.675 699.318 l 116.629 699.372 116.577 699.459 116.534 699.59 c 116.489 699.683 116.614 699.882 v 116.836 700.085 117.553 700.935 v 117.761 701.29 117.597 701.523 v 117.438 701.757 117.158 701.941 v 117.14 701.235 l b* Q q 1.0111 0 0 0.989 0 0 cm 0.137 0.122 0.125 RG 0.14 w 2.613 M 117.002 696.115 m 117.023 696.039 117.012 695.945 116.919 695.839 c 116.72 695.553 l 116.944 695.647 117.051 695.782 v 117.185 695.913 117.152 696.156 v 117.13 696.272 117.014 696.459 v 117.002 696.115 l b* Q 0.137 0.122 0.125 rg 164.39 652.821 m 164.661 652.982 165.489 654.206 165.521 654.155 c 166.017 653.387 166.694 652.611 168.141 652.611 c 169.588 652.611 170.76 653.302 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604.172 111.381 604.197 111.403 604.223 c 111.531 604.272 111.681 604.223 111.81 604.322 c 111.898 604.39 111.959 604.471 112.067 604.52 c 112.088 604.545 112.131 604.794 112.11 604.794 c 112.023 604.818 111.895 604.67 111.81 604.621 c 111.745 604.621 111.724 604.545 111.66 604.52 c 111.381 604.421 111.359 604.57 111.102 604.396 c 110.952 604.297 110.459 604.322 110.33 604.147 c f 111.251 603.525 m 111.488 603.5 111.702 603.6 111.917 603.674 c 112.11 603.749 112.324 603.848 112.496 604.023 c 112.131 604.122 111.81 603.823 111.445 603.724 c 111.403 603.724 111.295 603.65 111.316 603.55 c f 111.766 603.227 m 111.81 603.078 112.003 603.102 112.088 603.152 c 112.26 603.277 112.517 603.326 112.56 603.575 c 112.475 603.575 112.41 603.6 112.324 603.55 c 112.26 603.5 112.216 603.45 112.174 603.376 c 112.088 603.251 111.917 603.351 111.83 603.203 c f 112.539 602.828 m 112.71 602.828 112.882 602.828 113.054 602.828 c 113.032 603.028 113.096 603.227 113.225 603.376 c 113.225 603.401 113.225 603.45 113.225 603.476 c 113.118 603.525 113.032 603.401 112.946 603.326 c 112.882 603.251 112.882 603.127 112.903 603.028 c 112.797 603.028 112.689 602.978 112.624 602.879 c f 113.417 602.704 m 113.611 602.754 113.718 602.953 113.89 603.028 c f 113.911 602.729 m 114.04 602.729 114.104 602.928 114.211 603.028 c f 114.405 602.704 m 114.561 602.704 114.726 602.629 114.876 602.704 c 114.876 602.779 l 114.77 602.828 114.726 603.028 114.598 602.978 c 114.576 602.978 114.554 602.854 114.512 602.803 c 114.49 602.803 114.469 602.803 114.448 602.803 c 114.405 602.779 114.384 602.704 114.405 602.704 c f 125.503 607.772 m 121.236 606.754 l 121.257 606.754 121.257 606.779 121.278 606.779 c 121.172 606.455 121.044 606.132 120.957 605.784 c 120.838 605.301 120.957 604.764 120.979 604.267 c 121.194 604.366 121.215 604.516 v 121.301 604.864 121.301 605.113 121.386 605.461 c 121.407 605.486 121.537 605.611 121.558 605.659 c 121.699 605.989 121.88 606.033 122.18 606.208 c 122.523 606.381 122.865 606.656 123.187 606.804 c 123.873 607.103 124.603 607.153 125.268 607.476 c 125.289 607.502 125.354 607.527 125.375 607.602 c 125.39 607.654 125.567 607.652 125.503 607.772 c f 124.452 606.93 m 124.41 606.88 124.367 606.78 124.324 606.756 c 124.131 606.656 123.938 606.68 123.746 606.68 c 123.789 606.706 123.831 606.756 123.873 606.756 c 124.11 606.756 124.259 606.83 124.452 606.93 c f 123.81 606.283 m 123.616 606.283 123.445 606.308 123.252 606.283 c 123.231 606.258 123.252 606.208 123.274 606.183 c 123.445 606.132 123.616 606.034 123.789 605.984 c 123.831 605.959 123.895 605.984 y 123.981 605.91 124.204 605.876 124.174 605.959 c 124.131 606.083 123.981 606.158 123.873 606.233 c f 123.789 605.437 m 123.725 605.437 123.66 605.411 123.595 605.461 c 123.466 605.561 123.252 605.71 123.102 605.735 c f 123.274 605.063 m 123.08 605.063 122.845 605.013 122.695 605.088 c 122.631 605.138 122.544 605.237 122.502 605.362 c 122.78 605.312 122.953 605.138 123.231 605.138 c f 121.944 604.889 m 121.987 604.889 122.03 604.914 122.073 604.889 c 122.222 604.789 122.395 604.764 122.502 604.616 c 122.544 604.541 122.544 604.442 122.544 604.366 c 122.502 604.366 122.459 604.342 122.438 604.366 c 122.33 604.565 122.137 604.615 122.03 604.789 c f 122.33 603.968 m 122.33 603.944 122.33 603.894 122.33 603.869 c 122.073 603.794 121.901 604.018 121.708 604.192 c 121.558 604.316 121.708 604.417 121.837 604.316 c 121.901 604.267 122.009 604.192 122.094 604.118 c 122.159 604.042 122.266 604.093 122.352 604.018 c 122.33 603.993 122.33 603.968 v f 121.515 603.769 m 121.408 603.769 121.386 603.893 121.301 603.943 c f 121.044 603.745 m 121.044 603.694 121.044 603.669 121.044 603.619 c 121 603.619 l 121 603.57 121 603.495 121 603.446 c f 129.664 608.597 m 129.535 608.622 129.428 608.573 129.32 608.523 c 129.299 608.523 129.256 608.473 129.214 608.448 c 129.085 608.399 128.956 608.349 128.827 608.299 c 128.42 608.174 127.99 608.199 127.605 607.976 c 127.455 607.901 127.284 607.826 127.134 607.776 c 126.725 607.677 126.361 607.677 125.954 607.602 c 125.889 607.577 125.826 607.502 125.741 607.502 c 126.168 607.527 126.598 607.452 127.047 607.527 c 127.284 607.578 127.52 607.552 127.755 607.627 c 127.82 607.652 127.841 607.727 127.905 607.751 c 128.142 607.826 128.356 607.727 128.569 607.801 c 128.656 607.826 128.763 607.826 128.849 607.876 c 129.149 607.976 129.342 608.249 129.578 608.498 c 129.6 608.523 129.557 608.573 129.6 608.597 c f 129.171 607.727 m 129.085 607.628 129.021 607.502 128.892 607.453 c 128.677 607.404 128.484 607.254 128.27 607.203 c 128.013 607.129 127.777 607.08 127.52 607.054 c 127.198 607.004 126.898 607.004 126.576 606.906 c 126.555 606.906 126.489 606.89 126.468 606.88 c 125.975 606.656 125.46 606.756 124.968 606.756 c 124.946 606.905 125.01 607.104 125.161 607.128 c 125.396 607.179 125.611 607.054 125.847 607.029 c 126.147 606.98 126.426 606.98 126.725 607.03 c 126.834 607.054 126.919 607.08 127.006 607.128 c 127.284 607.254 127.562 607.129 127.841 607.254 c 127.949 607.303 128.035 607.328 128.142 607.379 c 128.441 607.453 128.742 607.502 129.021 607.627 c f 128.142 606.507 m 127.669 606.482 127.176 606.607 126.705 606.456 c 126.619 606.432 126.555 606.308 126.447 606.284 c 126.276 606.258 126.104 606.308 125.933 606.333 c 125.568 606.408 125.203 606.308 124.838 606.382 c 125.483 605.885 126.319 606.059 127.047 606.109 c 127.22 606.109 127.348 606.259 127.498 606.284 c 127.626 606.284 127.777 606.284 127.906 606.333 c 127.971 606.358 128.013 606.408 128.078 606.432 c f 126.898 605.362 m 126.919 605.388 126.876 605.412 126.876 605.437 c 126.49 605.412 126.104 605.537 125.718 605.611 c 125.289 605.685 124.861 605.512 124.431 605.685 c 124.496 605.661 124.563 605.632 124.624 605.611 c 125.376 605.362 126.04 605.412 126.769 605.388 c f 126.062 604.666 m 125.826 604.616 125.525 604.666 125.29 604.666 c 124.99 604.715 124.673 604.645 124.367 604.715 c 124.153 604.765 124.174 604.939 123.917 605.213 c 124.239 605.189 124.388 605.164 124.774 605.189 c 125.019 605.203 125.182 605.038 125.419 604.965 c 125.611 604.915 125.611 605.014 125.761 604.89 c f 125.247 604.068 m 124.904 604.043 124.582 604.068 124.239 604.144 c 124.218 604.168 124.174 604.193 124.153 604.218 c 124.025 604.268 123.873 604.218 123.746 604.317 c 123.656 604.387 123.595 604.466 123.488 604.516 c 123.467 604.541 123.424 604.79 123.445 604.79 c 123.531 604.815 123.66 604.666 123.746 604.616 c 123.81 604.616 123.831 604.541 123.895 604.517 c 124.174 604.417 124.196 604.566 124.452 604.392 c 124.604 604.292 125.096 604.317 125.225 604.144 c f 124.303 603.521 m 124.067 603.496 123.853 603.596 123.638 603.67 c 123.445 603.745 123.231 603.844 123.059 604.018 c 123.424 604.118 123.746 603.82 124.11 603.719 c 124.153 603.719 124.26 603.645 124.239 603.546 c f 123.789 603.222 m 123.746 603.073 123.553 603.098 123.467 603.147 c 123.295 603.272 123.038 603.322 122.995 603.571 c 123.08 603.571 123.145 603.596 123.231 603.546 c 123.295 603.496 123.339 603.447 123.381 603.371 c 123.467 603.247 123.638 603.346 123.725 603.198 c f 123.017 602.825 m 122.845 602.825 122.673 602.825 122.502 602.825 c 122.523 603.023 122.459 603.222 122.33 603.37 c 122.33 603.396 122.33 603.446 122.33 603.471 c 122.438 603.52 122.523 603.396 122.608 603.321 c 122.673 603.246 122.673 603.123 122.652 603.023 c 122.76 603.023 122.866 602.973 122.931 602.874 c f 122.138 602.699 m 121.945 602.75 121.837 602.948 121.665 603.022 c f 121.645 602.724 m 121.515 602.724 121.451 602.923 121.343 603.022 c f 121.151 602.699 m 120.994 602.699 120.829 602.624 120.679 602.699 c 120.679 602.774 l 120.786 602.823 120.829 603.022 120.957 602.973 c 120.979 602.973 121 602.849 121.044 602.799 c 121.065 602.799 121.086 602.799 121.108 602.799 c 121.151 602.774 121.172 602.699 121.151 602.699 c f q 1.0111 0 0 0.989 0 0 cm 0.11 G 1 J 1 j 0.281 w 4 M 115.851 613.096 m 116.042 613.033 116.247 613 116.461 613 c 117.504 613 118.35 613.812 118.35 614.814 c 118.35 615.816 117.504 616.628 116.461 616.628 c 115.417 616.628 114.571 615.816 114.571 614.814 c 114.571 614.017 115.106 613.34 115.851 613.096 c B Q q 1.0111 0 0 0.989 0 0 cm 0.158 G 0.14 w 4 M 115.704 613.805 m 116.013 614.819 l 115.23 615.382 l 116.214 615.384 l 116.524 616.317 l 116.883 615.379 l 117.944 615.381 l 117.09 614.775 l 117.46 613.805 l 116.598 614.429 l 115.704 613.805 l b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.535 611.835 m 116.768 611.835 116.955 611.971 116.955 612.142 c 116.955 612.312 116.768 612.449 116.535 612.449 c 116.304 612.449 116.116 612.312 116.116 612.142 c 116.116 611.971 116.304 611.835 116.535 611.835 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.535 612.142 m B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.284 611.897 m 116.284 611.836 116.396 611.786 116.535 611.786 c 116.675 611.786 116.788 611.836 116.788 611.897 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.65 611.804 m 116.535 608.207 l 116.422 611.804 l B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 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611.75 114.73 611.75 115.223 611.968 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 114.715 611.75 m 114.715 611.677 115.006 611.721 115.441 611.968 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 114.991 611.735 m 114.991 611.663 115.18 611.633 115.586 611.909 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 115.18 611.707 m 115.135 611.562 115.47 611.677 115.702 611.837 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 115.34 611.663 m 115.34 611.591 115.614 611.633 115.76 611.764 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 115.572 611.62 m 115.572 611.547 115.76 611.547 115.818 611.663 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 115.76 611.562 m 115.76 611.489 115.934 611.503 115.977 611.591 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 115.76 611.562 m 115.76 611.489 115.934 611.503 115.977 611.591 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 115.919 611.518 m 115.919 611.446 116.093 611.46 116.137 611.547 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.064 611.489 m 116.064 611.416 116.238 611.431 116.282 611.518 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.224 611.446 m 116.224 611.373 116.398 611.387 116.441 611.475 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.906 610.231 m 116.977 610.238 117.152 610.329 117.196 610.386 c 117.438 610.709 117.021 610.829 116.833 610.829 c 116.751 610.829 116.489 610.779 116.132 610.822 c 115.777 610.866 115.716 610.966 115.746 611.068 c 115.757 611.104 115.898 611.147 115.929 611.112 c 115.961 611.076 116.021 611.025 116.091 611.039 c 116.163 611.053 116.315 611.083 116.325 611.118 c 116.335 611.155 116.26 611.264 116.209 611.286 c 116.158 611.308 115.927 611.373 115.775 611.299 c 115.717 611.273 115.317 611.025 115.673 610.764 c 116.027 610.503 116.553 610.648 116.732 610.634 c 117.094 610.604 117.16 610.371 116.652 610.314 c 116.717 610.31 116.863 610.281 116.906 610.231 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.833 610.829 m 117.188 610.872 117.361 610.966 117.33 611.068 c 117.32 611.104 117.178 611.147 117.148 611.112 c 117.118 611.076 117.057 611.025 116.985 611.039 c 116.915 611.053 116.762 611.083 116.751 611.118 c 116.741 611.155 116.84 611.264 116.89 611.286 c 116.942 611.308 117.203 611.358 117.355 611.286 c 117.411 611.258 117.772 611.094 117.411 610.836 c 117.321 610.771 117.198 610.749 117.166 610.749 c B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.829 609.886 m 117.018 609.857 117.101 610.241 116.767 610.295 c 116.407 610.354 116.323 610.359 116.234 610.368 c 116.068 610.386 116.079 610.619 116.449 610.611 c 116.177 610.608 l 115.719 610.597 115.875 610.195 116.238 610.215 c 116.602 610.238 116.874 610.165 116.783 610.027 c 116.727 609.942 116.674 609.923 y 116.759 609.923 116.812 609.897 116.829 609.886 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.787 609.556 m 116.913 609.527 117.074 609.856 116.741 609.915 c 116.419 609.973 116.366 609.938 116.298 609.979 c 116.198 610.038 116.231 610.238 116.466 610.215 c 116.296 610.213 l 115.956 610.259 115.966 609.861 116.239 609.861 c 116.51 609.861 116.844 609.807 116.756 609.673 c 116.707 609.596 116.641 609.593 y 116.717 609.593 116.75 609.574 116.787 609.556 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.764 609.233 m 116.884 609.205 116.954 609.54 116.719 609.581 c 116.429 609.633 116.382 609.602 116.32 609.639 c 116.231 609.692 116.224 609.853 116.481 609.843 c 116.333 609.853 l 116.01 609.915 116.05 609.513 116.293 609.513 c 116.535 609.513 116.742 609.506 116.733 609.364 c 116.728 609.302 116.641 609.27 y 116.71 609.27 116.742 609.256 116.764 609.233 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.739 608.965 m 116.89 608.939 116.906 609.237 116.69 609.263 c 116.441 609.294 116.403 609.304 116.351 609.335 c 116.274 609.38 116.354 609.513 116.489 609.506 c 116.333 609.517 l 116.101 609.559 116.1 609.221 116.307 609.221 c 116.513 609.221 116.768 609.181 116.702 609.078 c 116.663 609.02 116.627 609.005 y 116.684 609.005 116.71 608.987 116.739 608.965 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.688 608.755 m 116.787 608.762 116.819 608.973 116.658 609.001 c 116.462 609.036 116.433 609.013 116.39 609.038 c 116.33 609.074 116.369 609.215 116.495 609.211 c 116.369 609.215 l 116.167 609.256 116.185 608.941 116.351 608.941 c 116.516 608.941 116.721 608.909 116.667 608.827 c 116.631 608.77 116.605 608.787 y 116.637 608.781 116.674 608.762 116.688 608.755 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.542 608.443 m 116.565 608.542 116.633 608.584 116.663 608.61 c 116.764 608.664 116.736 608.756 116.627 608.784 c 116.555 608.802 116.467 608.799 116.439 608.817 c 116.395 608.842 116.38 608.936 116.511 608.929 c 116.43 608.939 l 116.188 608.929 116.285 608.737 116.427 608.741 c 116.542 608.742 116.684 608.708 116.59 608.639 c 116.517 608.586 116.55 608.555 116.542 608.443 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.395 608.743 m 116.34 608.727 116.293 608.633 116.376 608.599 c 116.456 608.566 116.529 608.509 116.529 608.399 c 116.532 608.48 116.532 608.62 116.463 608.632 c 116.371 608.647 116.434 608.729 116.485 608.737 c 116.395 608.743 l b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.068 611.089 m 116.085 611.089 116.098 611.103 116.098 611.118 c 116.098 611.136 116.085 611.15 116.068 611.15 c 116.051 611.15 116.038 611.136 116.038 611.118 c 116.038 611.103 116.051 611.089 116.068 611.089 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 116.068 611.118 m B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 117.025 611.089 m 117.043 611.089 117.057 611.103 117.057 611.118 c 117.057 611.136 117.043 611.15 117.025 611.15 c 117.008 611.15 116.994 611.136 116.994 611.118 c 116.994 611.103 117.008 611.089 117.025 611.089 c b Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 117.025 611.118 m B Q q 1.0111 0 0 0.989 0 0 cm 0 G 2 j 0.028 w 10 M 114.208 611.865 m 113.947 611.75 113.556 611.547 113.729 611.503 c 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Embedded)]TJ 0 -1.302 TD -0.0036 Tc 0.0547 Tw (within these patient assailants is a small group of repeat offenders who present a serious increased risk)Tj 0 -1.299 TD 0.0666 Tw [(for assault. This study examined the demographic and clinical variables of repeat offenders over a 15-)]TJ T* 0.0914 Tw [(year period. Included in the sample were patients who were transferred from correctional facilities to)]TJ 0 -1.302 TD 0.0877 Tw [(mental health facilities and then to the community)50.4(. The r)32.4(esults indicated that older)107.4(, male patients with)]TJ 0 -1.299 TD -0.0003 Tw (schizophrenia and younger patients with personality disorders were the more likely to re-offend. The risk)Tj T* 0.0096 Tc 0.125 Tw (of assault was greatly increased if these patients had histories of violence toward others, personal)Tj 0 -1.302 TD -0.0038 Tc 0.0741 Tw [(victimization, and substance use disor)32.2(der)104.2(. Corr)34.4(ection patients did not appear to pr)32.2(esent any additional)]TJ 0 -1.299 TD -0.0035 Tc 0.0769 Tw [(risk per se. The significance of the findings and the implications for emergency services personnel are)]TJ T* 0.0785 Tw (presented. [International Journal of Emergency Mental Health, 2008, 10\(1\), pp. 1-8].)Tj /TT1 1 Tf 9 0 0 9 117.9 321 Tm -0.0055 Tc -0.0139 Tw (Key words: )Tj /TT7 1 Tf 5.0833 0 TD -0.0049 Tc -0.0161 Tw (Assaults, Assaulted Staff Action Program \(ASAP\), correction patients, emergency services, repetitively)Tj 9.5 -1.3333 TD -0.0051 Tc -0.0111 Tw (assaultive patients, violence)Tj ET /GS1 gs 66 114.765 m 303 114.765 l S BT 9 0 0 9 66 96.99 Tm /GS2 gs 0.0219 Tc 0.1254 Tw [(Raymond B. Flannery)55.7(,)-0.9( Jr)101.9(., Ph.D., Department of Psychology)]TJ 0 -1.22 TD -0.0051 Tc -0.0484 Tw [(W)94.6(o)7.4(r)31.6(cester S)28.2(tate Hospital, 305 Belmont S)31.6(t)5.2(r)34.9(eet W)84.9(o)7.4(r)31.6(cester)108.2(, MA)11.6( 01604.)]TJ 0 -1.2233 TD -0.0037 Tc 0 Tw (E-mail:Raymond.Flannery@dmh.state.ma.us)Tj /F1 1 Tf 14 0 0 14 160.26 656.34 Tm 0.0035 Tc 0.1383 Tw [(Repetitivel)7.8(y Assaultive Psyc)7.8(hiatric P)24.9(atients:)]TJ 4.0457 -1.1421 TD -0.0022 Tc 0.1382 Tw [(Fifteen-Y)72.8(ear Anal)6.4(ysis of the)]TJ -7.2064 -1.1421 TD -0.0026 Tc 0.1375 Tw (Assaulted Staff Action Program \(ASAP\) with Implications)Tj 8.0357 -1.1443 TD 0.0056 Tc (for Emergency Services)Tj /TT2 1 Tf 10 0 0 10 84.99 263.64 Tm -0.0034 Tc 0.02 Tw (Research has demonstrated that psychiatric patient as-)Tj -1.8 -1.398 TD -0.0036 Tc -0.005 Tw (saults on emergency medical services \(EMS\) personnel are)Tj 0 -1.401 TD -0.011 Tw [(a nationwide concern \(Cheney)59.5(, Gossett, Fullerton-Gleason,)]TJ T* -0.0038 Tc -0.0624 Tw [(W)94(eiss, Ernst, & Sklar)35.2(, 2006; Mechem, Dickinson, Shofer)35.2(, &)]TJ 0 -1.398 TD -0.0235 Tc [(Jaslow)60.5(, 2002; )15.7(T)38.3(intinalli & McCoy)57.5(, 1993; )15.7(W)95.3(eiss, Ernst, Phillips,)]TJ 0 -1.401 TD -0.0088 Tc -0.0625 Tw [(& Hill, 2001\). These assaults are committed by patients with)]TJ T* -0.0096 Tc [(various forms of psychiatric disorganization, organic impair-)]TJ 0 -1.398 TD 0.0044 Tc 0.125 Tw [(ment, and/or substance use disorders \(Flannery)58.4(, Juliano,)]TJ 0 -1.401 TD -0.0038 Tc 0.0407 Tw [(Cronin, & )14.3(W)97(alker)35.2(, 2006; Grange & Corbett, 2002\) in both)]TJ T* -0.0099 Tw [(home and non-home settings \(W)74.1(eiss et al., 2001\).)]TJ 12 0 0 12 396.51 555.66 Tm -0.0099 Tc -0.0611 Tw [(Andrew P)105.1(.)-0.3( )9.4(W)83.9(alker)]TJ 10 0 0 10 338.4 543 Tm 0.001 Tc 0.07 Tw (The Massachusetts Department of Mental Health)Tj 12 0 0 12 127.26 555.66 Tm -0.0213 Tc -0.0612 Tw [(Raymond B. Flannery)58.7(, Jr)]TJ 10 0 0 10 83.4 543 Tm 0.001 Tc 0.07 Tw (The Massachusetts Department of Mental Health)Tj 3.786 -1.2 TD 0.0014 Tc -0.0164 Tw [( and Harvard Medical School)]TJ 21.774 -26.784 TD -0.0036 Tc 0.068 Tw (Embedded among these assaultive psychiatric patients)Tj -1.8 -1.401 TD 0.03 Tw (is a small subset of offenders who account for a substantial)Tj T* 0.0088 Tc 0.125 Tw [(percentage of these assaults. They are known as repeat)]TJ 0 -1.398 TD -0.0033 Tc 0.1218 Tw [(offenders \(three or more documented assaults\). The only)]TJ 0 -1.401 TD -0.0062 Tc -0.0622 Tw [(review of this literature to date \(Flannery)62.8(, 2002\) found repeti-)]TJ T* -0.0028 Tc -0.0499 Tw [(tively violent patients to be younger)36.2(, equally male or female,)]TJ 0 -1.398 TD -0.0035 Tc 0.1164 Tw (and most frequently diagnosed with schizophrenia or per-)Tj 0 -1.401 TD -0.0034 Tc 0.01 Tw [(sonality disorders. These repeat offenders comprised about)]TJ T* -0.0043 Tc -0.0623 Tw (10% of a population of assaultive patients yet they accounted)Tj 0 -1.398 TD -0.0033 Tc 0.004 Tw (for about 30% of all assaults. Thus, it would appear impor-)Tj 0 -1.401 TD -0.0032 Tc 0.1055 Tw (tant for EMS to routinely inquire with the patient about a)Tj T* 0.1067 Tw (history of previous assaults.)Tj 1.8 -1.998 TD 0.0012 Tc 0.125 Tw (The risk of EMS encountering such repeat offenders)Tj -1.8 -1.401 TD -0.0026 Tc 0.0354 Tw (may have been further increased in the past five years by a)Tj ET endstream endobj 55 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 59 0 obj << /Length 8761 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0046 Tc 0.1125 Tw [(2 )]TJ /TT3 1 Tf 1.7138 0 TD -0.0054 Tc [(Flannery and Walker Repetitively Assaultive Psychiatric Patients)]TJ /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0035 Tc -0.0621 Tw (nationwide initiative to transfer psychiatric patients in prison)Tj 0 -1.398 TD -0.0037 Tc 0.0479 Tw (for criminal offenses from state Departments of Correction)Tj 0 -1.401 TD -0.0038 Tc 0.0027 Tw (\(DOC\) to state Departments of Mental Health \(DMH\). The)Tj T* -0.0034 Tc 0.0122 Tw (goal of these step-down transfers is to evaluate each patient)Tj 0 -1.398 TD -0.003 Tc 0.0222 Tw (for discharge; to stabilize each patient, if necessary; and, in)Tj 0 -1.401 TD -0.0034 Tc 0.084 Tw [(time, to place each patient in a community setting. When)]TJ T* -0.0033 Tc 0.1172 Tw (EMS are called to community settings, it is reasonable to)Tj 0 -1.398 TD -0.0036 Tc 0.0305 Tw (consider whether EMS are at increased risk of assault from)Tj 0 -1.401 TD -0.0037 Tc 0.0519 Tw (these transferred patients who are now residing in commu-)Tj T* 0.0011 Tc 0.125 Tw (nity settings.)Tj 1.8 -1.998 TD -0.0028 Tc 0 Tw (This study begins to address this question by analyzing)Tj -1.8 -1.401 TD -0.0031 Tc -0.0325 Tw (the characteristics of repetitively violent patients in a mental)Tj T* -0.0028 Tc 0.0668 Tw (health care system that for the past five years has been re-)Tj 0 -1.398 TD -0.0034 Tc 0.1221 Tw [(ceiving transferred correctional patients. Several of these)]TJ 0 -1.401 TD -0.0033 Tc 0.0957 Tw [(patients have been subsequently placed in the community)59.7(.)]TJ T* -0.0028 Tc -0.0019 Tw (A previous 10-year study of the repetitively violent patients)Tj 0 -1.398 TD -0.0069 Tc -0.062 Tw [(in this same health care system \(Flannery)62.1(, Rachlin, & )17.3(W)90.9(alker)38.1(,)]TJ 0 -1.401 TD -0.0046 Tc 0 Tw (2002\) )Tj /TT7 1 Tf 2.58 0 TD -0.0051 Tc (before)Tj /TT2 1 Tf 2.529 0 TD -0.0035 Tc 0.025 Tw [( the corrections transfers had begun found that)]TJ -5.109 -1.401 TD -0.0037 Tc 0.1222 Tw (10% of the assaultive patients had committed 31% of the)Tj 0 -1.398 TD -0.0034 Tc 0.0516 Tw [(total assaults. In terms of demographic variables these pa-)]TJ 0 -1.401 TD -0.0032 Tc 0.0205 Tw (tients were on average 33 years of age, were both male and)Tj T* -0.0035 Tc -0.0214 Tw (female, and were primarily diagnosed with schizophrenia or)Tj 0 -1.398 TD -0.0067 Tc -0.0624 Tw [(personality disorder)47.3(. In addition, three common clinical vari-)]TJ 0 -1.401 TD -0.0034 Tc 0.125 Tw [(ables were identified. Most patients had histories of vio-)]TJ T* -0.0036 Tc 0.0172 Tw [(lence toward others and personal victimization. )14.5(T)73.2(w)1.1(o-thirds)]TJ 0 -1.398 TD 0.0332 Tw [(had substance use disorders. )50.4(A)58.7( comparison of these repeti-)]TJ 0 -1.401 TD -0.0031 Tc 0.0473 Tw (tively violent patients with their non-repetitively assaultive)Tj T* -0.0037 Tc 0.0243 Tw (peers revealed no differences on the demographic variables)Tj 0 -1.398 TD -0.0041 Tc -0.0622 Tw (but there was a significantly higher association of the clinical)Tj 0 -1.401 TD 0.059 Tc 0.258 Tw (variable of personal victimization with repetitive)Tj T* -0.0034 Tc 0.0022 Tw (assaultiveness. This previous study thus provides a baseline)Tj 0 -1.398 TD 0.035 Tw [(for comparison with the present study)59.6(.)]TJ 1.8 -2.001 TD -0.0032 Tc 0.0618 Tw [(The purpose of the present, retrospective study was to)]TJ -1.8 -1.401 TD 0.095 Tw (assess the characteristics of repetitively assaultive patients)Tj 0 -1.398 TD -0.0193 Tw (and non-repetitively assaultive patients during a 15-year pe-)Tj 0 -1.401 TD 0.125 Tw (riod in which corrections patients were transferred to this)Tj T* -0.0026 Tc 0.117 Tw [(health care system during the last five years of the study)60.4(.)]TJ 0 -1.398 TD -0.0087 Tc -0.0625 Tw (The study included basic demographic variables and the three)Tj 0 -1.401 TD -0.0035 Tc -0.0507 Tw (clinical variables of violence toward others, personal victim-)Tj T* 0.0117 Tw [(ization, and substance use disorder)53.4(. Based on previous em-)]TJ 0 -1.398 TD -0.0032 Tc 0.0257 Tw [(pirical research and clinical anecdotal evidence, the study)50.8(s)]TJ 0 -1.401 TD 0.0052 Tc 0.125 Tw (first hypothesis predicted that the demographic variables)Tj T* -0.0032 Tc 0.09 Tw (would not be predictor variables and that only the clinical)Tj 0 -1.398 TD -0.0035 Tc -0.0238 Tw (variable of personal victimization would be a predictor vari-)Tj 0 -1.401 TD -0.0031 Tc 0.0988 Tw [(able. Its second hypothesis predicted that the presence of)]TJ T* 0.065 Tw (transferred correction patients would yield no significantly)Tj 25.5 64.2 TD -0.0065 Tc -0.0622 Tw (altered assault characteristic findings, as these patients would)Tj 0 -1.398 TD -0.0035 Tc 0.0294 Tw [(have been assessed and stabilized at time of transfer)50.5(.)]TJ /F1 1 Tf 11 0 0 11 403.14 667.2 Tm 0.0198 Tc 0 Tw (METHOD)Tj -8.5582 -1.4536 TD -0.0013 Tc (Subjects)Tj /TT2 1 Tf 10 0 0 10 327 627.84 Tm -0.0038 Tc 0.0858 Tw (The subjects were 73 male and 81)Tj /TT1 1 Tf 14.004 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.336 0 TD -0.003 Tc 0.09 Tw (female repetitively)Tj -16.14 -1.398 TD -0.0035 Tc 0.0728 Tw [(assaultive psychiatric from the Massachusetts DMH. This)]TJ 0 -1.401 TD -0.0037 Tc -0.0216 Tw (sample was drawn from a population of 2,103 assaultive pa-)Tj T* -0.0035 Tc -0.039 Tw [(tients. There were 797 male and 757 female assaultive inpa-)]TJ 0 -1.398 TD 0.1223 Tw (tients and 250 male and 299 female assaultive patients in)Tj 0 -1.401 TD -0.0031 Tc -0.0144 Tw [(community settings. Subjects average age was 15.77 years)]TJ T* 0 Tc 0 Tw (\()Tj ET 500 w 317.67 -456.16 m 312.21 -456.16 l S BT 10 0 0 10 312.21 543.84 Tm -0.0164 Tc -0.0617 Tw (+ 2.46\) for child/adolescent patients and 39.89 years \()Tj ET 519.36 -456.16 m 513.9 -456.16 l S BT 10 0 0 10 513.9 543.84 Tm -0.0175 Tc -0.0648 Tw (+ 14.14\))Tj -20.49 -1.398 TD -0.0034 Tc 0.015 Tw (for adults. The sample was primarily Caucasian \(74%\), and)Tj 0 -1.401 TD -0.0037 Tc -0.0114 Tw [(Black \(16%\). Major diagnoses for child/adolescent patients)]TJ T* 0.0692 Tw (were schizophrenia \(4%\), major affective disorders \(19%\),)Tj 0 -1.398 TD -0.0036 Tc 0 Tw (and posttraumatic stress disorders \(17%\). Major diagnoses)Tj 0 -1.401 TD -0.0271 Tw (for adult patients were schizophrenia \(51%\), major affective)Tj T* -0.0058 Tc -0.0625 Tw [(disorders \(24%\), and personality disorders \(7%\). These find-)]TJ 0 -1.398 TD -0.0031 Tc 0.1238 Tw (ings were generally consistent throughout the 15 years of)Tj 0 -1.401 TD 0.0027 Tc 0.125 Tw [(this study)62.7(.)]TJ /F1 1 Tf 11 0 0 11 309 399.21 Tm -0.0049 Tc 0.0227 Tw (Measures of Assault)Tj /TT2 1 Tf 10 0 0 10 327 375.84 Tm 0.0059 Tc 0.125 Tw (The four types of assaults included in this study re-)Tj -1.8 -1.398 TD -0.0034 Tc 0.0615 Tw (mained the same as they have been since the program was)Tj 0 -1.401 TD -0.0033 Tc -0.057 Tw [(fielded in 1990. Physical assaults were defined as unwanted)]TJ T* -0.0036 Tc 0.0825 Tw (contact with another person with intent to harm, including)Tj 0 -1.398 TD 0.1092 Tw (punching, kicking, slapping, biting, spitting, and throwing)Tj 0 -1.401 TD 0.0005 Tc 0.125 Tw [(objects directly at staff. Sexual assaults were unwanted)]TJ T* -0.0035 Tc -0.0121 Tw (sexual contacts and included rape, attempted rape, fondling,)Tj 0 -1.398 TD 0.0925 Tw [(forced kissing, and exposing. Nonverbal intimidation re-)]TJ 0 -1.401 TD -0.0033 Tc 0.0893 Tw (ferred to actions intended to threaten and/or frighten staff,)Tj T* -0.0038 Tc 0.0239 Tw [(such as pounding on the staf)14.2(f of)17.2(fice door)38.2(, random throwing)]TJ 0 -1.398 TD -0.0031 Tc -0.0012 Tw [(of objects, and destruction of property)59.9(. )18.7(V)116.1(erbal threats were)]TJ 0 -1.401 TD -0.0035 Tc 0.0413 Tw (statements meant to frighten or threaten staff, and included)Tj T* -0.0031 Tc 0.078 Tw [(threats against life and property as well as racial slurs and)]TJ 0 -1.398 TD -0.0035 Tc 0.045 Tw (other derogatory comments.)Tj /F1 1 Tf 11 0 0 11 309 161.19 Tm 0.0039 Tc 0 Tw (Procedure)Tj /TT2 1 Tf 10 0 0 10 327 137.85 Tm -0.0035 Tc 0.0908 Tw (The characteristics of patient assailants were gathered)Tj -1.8 -1.401 TD -0.004 Tc 0.0169 Tw [(from the medical chart and recorded on )50.2(Assaulted S)17(taf)14(f )50.2(Ac-)]TJ 0 -1.398 TD -0.0035 Tc 0.075 Tw [(tion Program \(ASAP\) report forms \(Flannery)62.5(,)-0.3( 1998\) at the)]TJ 0 -1.401 TD -0.0011 Tc 0.1253 Tw [(time of each incident, after )50.2(ASAP)34.9( services had been ren-)]TJ T* -0.0053 Tc 0.0128 Tw [(dered. )50.9(ASAP)30.7( )]TJ 5.667 0 TD -0.0026 Tc 0.0106 Tw [(\(Flannery)60.4(, 1998\) is a voluntary)63.4(, system-wide,)]TJ ET endstream endobj 60 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 62 0 obj << /Length 10730 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 431.91 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD 0 Tc 0 Tw (3)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm 0.125 Tw (peer-help, crisis intervention program to address the psy-)Tj 0 -1.398 TD -0.0033 Tc 0.0221 Tw (chological sequellae experienced by staff victims of patient)Tj 0 -1.401 TD -0.0049 Tc 0.0148 Tw [(assaults. )50.8(ASAP)31.1( )]TJ 6.5537 0 TD -0.0034 Tc 0.013 Tw [(includes individual, group, and staf)17.6(f victim)]TJ -6.5537 -1.401 TD -0.0032 Tc 0.0844 Tw (family crisis intervention services as well as staff victims)Tj 0 -1.398 TD -0.0493 Tw (support groups, staff-victim family outreach, and referrals to)Tj 0 -1.401 TD -0.0033 Tc 0.0556 Tw (individual trauma specialists, as indicated. )Tj 17.3194 0 TD -0.0055 Tc 0.0574 Tw [( )50.3(ASAP)30.5( has firm)]TJ -17.3194 -1.401 TD -0.0083 Tc -0.0626 Tw [(empirical support for its ef)15.7(ficacy \(Flannery)63.7(, 1998; Flannery et)]TJ 0 -1.398 TD -0.0124 Tc -0.062 Tw [(al., 2002; Flannery)62.6(, Juliano, Cronin, & )11.7(W)97.4(alker)35.6(, 2006\).)]TJ 1.8 -2.001 TD -0.008 Tc -0.0616 Tw [(ASAP)31( team members practiced completing )55.9(ASAP)31( report)]TJ -1.8 -1.401 TD -0.0032 Tc -0.0261 Tw (forms until acceptable levels of skill and reliability were ob-)Tj 0 -1.398 TD -0.0143 Tc -0.0625 Tw [(tained. Basic demographic data were gathered for all 15 years.)]TJ 0 -1.401 TD -0.0035 Tc 0.0137 Tw [(The clinical variable data were gathered beginning in 1994,)]TJ T* 0.0855 Tw (when the data base was expanded to capture this informa-)Tj 0 -1.398 TD -0.0169 Tc -0.0625 Tw [(tion. )19.1(T)74.9(o)0.1( guard against underreporting \(Lion, Snyder)37.1(, & Merrill,)]TJ 0 -1.401 TD -0.0134 Tc -0.0622 Tw (1981\), each facility was required to fill out a DMH report form)Tj T* -0.0031 Tc 0.0819 Tw [(for each incident, to call )]TJ 10.2667 0 TD -0.0046 Tc 0.0294 Tw [(the ASAP)28.4( )-54.1(person )]TJ 7.29 0 TD -0.003 Tc 0.0818 Tw [(on duty)60(, and to)]TJ -17.5566 -1.398 TD -0.0031 Tc 0.074 Tw [(review the incident at daily staf)17.9(f meetings. )50.9(At times, total)]TJ 0 -1.401 TD -0.0039 Tc 0.045 Tw (numbers do not equal 100% because of occasional missing)Tj T* -0.0137 Tw [(data when staf)14.2(f victims declined )]TJ 12.93 0 TD -0.0043 Tc -0.0128 Tw [(ASAP)28.7( services, declined to)]TJ -12.93 -1.398 TD -0.0032 Tc 0.1218 Tw [(identify the patient assailant, or when the patient)50.8(s record)]TJ 0 -1.401 TD -0.0034 Tc -0.0094 Tw [(did not include suf)14.6(ficient documentation of the study)53.6(s vari-)]TJ T* -0.003 Tc -0.0196 Tw [(ables. This analysis assumed that all staff were at equal risk)]TJ 0 -1.398 TD -0.0046 Tc -0.0622 Tw (for the full period, except for some brief hospitalizations dur-)Tj 0 -1.401 TD -0.0035 Tc 0.0221 Tw (ing which community patients were absent from residential)Tj T* -0.0023 Tc 0 Tw (placements.)Tj 1.8 -1.998 TD -0.0034 Tc 0.0931 Tw (This study reports on data from the 16 Massachusetts)Tj -1.8 -1.401 TD -0.0032 Tc 0.0867 Tw [(teams that were fielded during this 15-year period. These)]TJ T* -0.004 Tc 0.0135 Tw (included 7 DMH state hospitals and 9 DMH state or DMH-)Tj 0 -1.398 TD -0.0096 Tc -0.0623 Tw [(vendored community programs. Over the years, 3 DMH state)]TJ 0 -1.401 TD -0.004 Tc 0.0492 Tw [(hospitals and 3 DMH-vendored community programs have)]TJ T* -0.0033 Tc 0.08 Tw (been curtailed by closings, downsizings, privatization, and)Tj 0 -1.398 TD -0.0036 Tc 0.0825 Tw [(mergers with other facilities. No Massachusetts team was)]TJ 0 -1.401 TD -0.0029 Tc -0.062 Tw (online for the full 15-year period.)Tj 1.8 -2.001 TD 0.1134 Tw [(In this study)60.1(, repetitively assaultive patients were op-)]TJ -1.8 -1.398 TD -0.0034 Tc 0.05 Tw (erationally defined as patients who had committed three or)Tj 0 -1.401 TD -0.0031 Tc 0.0629 Tw [(more assaults during this 15-year period. Non-repetitively)]TJ T* -0.0038 Tc 0.0715 Tw (assaultive patients were those who had committed assaults)Tj 0 -1.398 TD -0.0005 Tc 0.125 Tw [(less than three times. Data are reported as unduplicative)]TJ 0 -1.401 TD -0.0036 Tc 0.086 Tw (counts of patients unless otherwise indicated.)Tj /F1 1 Tf 11 0 0 11 158.64 140.01 Tm 0.0198 Tc 0 Tw [(RESUL)82.5(TS)]TJ /TT2 1 Tf 10 0 0 10 84 116.64 Tm -0.0043 Tc -0.0001 Tw [(From 1990 to 2005, the Massachusetts )50.2(ASAP)28.7( teams re-)]TJ -1.8 -1.398 TD -0.0035 Tc 0.0479 Tw [(sponded to 2,152 patient assault )]TJ 13.1766 0 TD -0.0047 Tc 0.0507 Tw [(incidents on staf)16.3(f)-4.5(.)-4.4( )52(ASAP)]TJ -13.1766 -1.401 TD -0.0073 Tc -0.0625 Tw (services were accepted in 1,857 incidents \(86%\) and declined)Tj T* -0.0067 Tc -0.0622 Tw [(in 295 others \(14%\). There were 1,613 inpatient assault inci-)]TJ 25.5 64.8 TD -0.0139 Tc -0.0625 Tw (dents \(75%\) and 539 community assault incidents \(25%\) com-)Tj 0 -1.398 TD -0.0034 Tc -0.0267 Tw (mitted by 1,047 male \(49%\) and 1,056 female \(49%\) patient)Tj 0 -1.401 TD -0.0031 Tc -0.0084 Tw (assailants. The average age of all assailants was 35.04 years)Tj T* 0 Tc 0 Tw (\()Tj ET 500 w 329.91 -319.36 m 324.3 -319.36 l S BT 10 0 0 10 324.3 680.64 Tm -0.0051 Tc -0.0625 Tw [(+11.7\). In 49 incidents \(2%\), either the staff victim declined)]TJ -0.33 -1.398 TD -0.0033 Tc 0.0018 Tw (ASAP services and declined to identify the patient assailant)Tj 0 -1.401 TD -0.0043 Tc -0.0457 Tw [(or )51.1(ASAP)28.7( was notified )]TJ 8.7047 0 TD -0.0029 Tc -0.0471 Tw (so late after the fact that the identity of)Tj -8.7047 -1.401 TD -0.0033 Tc 0.0658 Tw (the patient could not be unequivocally established.)Tj 1.8 -1.998 TD -0.0118 Tc -0.0625 Tw (For the full 15-year period, there were 73 male \(47%\) and)Tj -1.8 -1.401 TD -0.0037 Tc 0.0305 Tw (81 female \(52%\) patients who committed three or more as-)Tj T* -0.0035 Tc 0.0515 Tw [(saults. These subjects were drawn from a sample of 1,286)]TJ 0 -1.398 TD -0.0037 Tc 0.0358 Tw [(assaultive patients. These repeat offenders comprised 12%)]TJ 0 -1.401 TD -0.0036 Tc -0.058 Tw (of the sample and committed 32% of the total assaults during)Tj T* -0.0059 Tc -0.0623 Tw [(this period. )48.1(As can be seen in )21.1(T)70.9(able 1, their average mean age)]TJ 0 -1.398 TD -0.011 Tc -0.0608 Tw (was 35.5 years \()Tj /TT7 1 Tf 6.141 0 TD -0.0222 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.188 0 TD -0.0116 Tc -0.0621 Tw [( = 11.9\) and they were primarily diagnosed)]TJ -7.329 -1.401 TD -0.0075 Tc -0.0625 Tw (with schizophrenia \(55%\),)Tj 10.8 0 TD 0.0145 Tc 0.1249 Tw [(affective disorders \(14%\), and)]TJ -10.8 -1.401 TD -0.0034 Tc 0.0886 Tw [(personality disorders \(17%\). These repeat offenders com-)]TJ 0 -1.398 TD -0.0035 Tc -0.0625 Tw (mitted 616 physical assaults \(85%\), 4 sexual assaults \(0.6%\),)Tj 0 -1.401 TD -0.0522 Tw (11 acts of nonverbal intimidation \(2%\), and 56 verbal threats)Tj T* -0.0034 Tc 0.0668 Tw [(\(8%\). )50.5(An additional analysis comparing the repetitive and)]TJ 0 -1.398 TD -0.0009 Tc 0.125 Tw (non-repetitive patients revealed no statistically significant)Tj 0 -1.401 TD -0.0037 Tc 0.0138 Tw (differences on the demographic variables.)Tj 1.8 -2.001 TD -0.0031 Tc 0.0814 Tw [(T)73.7(able 2 presents the characteristics of repetitively and)]TJ -1.8 -1.398 TD -0.0035 Tc -0.0425 Tw (non-repetitively assaultive patients on both the demographic)Tj 0 -1.401 TD -0.0032 Tc -0.0111 Tw [(and clinical variables for the years 1994-2005. The average)]TJ T* -0.0146 Tc -0.0625 Tw (age of the repeat offenders was 36.1 years \()Tj /TT7 1 Tf 16.269 0 TD -0.0222 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.191 0 TD -0.0149 Tc -0.0625 Tw [( = 12.98\). There)]TJ -17.46 -1.398 TD -0.0241 Tc -0.0616 Tw (were 55 males \(45%\) and 67 females \(55%\) who were primarily)Tj 0 -1.401 TD 0.0098 Tc 0.125 Tw (diagnosed with schizophrenia \(51%\), affective disorders)Tj T* -0.0033 Tc 0.1044 Tw [(\(16%\), and personality disorders \(22%\). These repeat of-)]TJ 0 -1.398 TD -0.0035 Tc -0.0069 Tw [(fenders had histories of violence towards others \(98%\), per-)]TJ 0 -1.401 TD -0.0075 Tc -0.0621 Tw (sonal victimization \(82%\), and substance use disorder \(70%\).)Tj T* 0.0015 Tc 0.125 Tw (An additional analysis comparing the repetitive and non-)Tj 0 -1.398 TD -0.0036 Tc 0.0321 Tw (repetitive assailants on the subset demographic and clinical)Tj 0 -1.401 TD -0.0032 Tc -0.0333 Tw (variables revealed statistically significant differences for the)Tj T* -0.0034 Tc 0.0158 Tw (clinical variables of violence toward others \()Tj /TT7 1 Tf 17.766 0 TD 0 Tc 0 Tw (x)Tj /TT2 1 Tf 5.8 0 0 5.8 503.04 245.31 Tm (2)Tj 10 0 0 10 505.95 248.64 Tm -0.0018 Tc 0.015 Tw [( = 7, )]TJ /TT7 1 Tf 2.1 0 TD -0.0068 Tc 0 Tw (df)Tj /TT2 1 Tf 0.771 0 TD -0.0025 Tc 0.0175 Tw [( =1, )]TJ /TT7 1 Tf 1.839 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf -23.205 -1.398 TD -0.0035 Tc -0.0233 Tw (<.01\), personal victimization \()Tj /TT7 1 Tf 11.97 0 TD 0 Tc 0 Tw (x)Tj /TT2 1 Tf 5.8 0 0 5.8 445.11 231.3 Tm (2)Tj 10 0 0 10 447.99 234.66 Tm -0.0027 Tc -0.0233 Tw [( =14.83, )]TJ /TT7 1 Tf 3.72 0 TD -0.0068 Tc 0 Tw (df)Tj /TT2 1 Tf 0.771 0 TD -0.0022 Tc -0.025 Tw [( =1, )]TJ /TT7 1 Tf 1.755 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0031 Tc -0.025 Tw [( <.01\), and)]TJ -19.44 -1.401 TD -0.0037 Tc -0.035 Tw (substance use disorder \()Tj /TT7 1 Tf 9.39 0 TD 0 Tc 0 Tw (x)Tj /TT2 1 Tf 5.8 0 0 5.8 419.31 217.29 Tm (2)Tj 10 0 0 10 422.19 220.65 Tm -0.0025 Tc -0.035 Tw [( = 6.26, )]TJ /TT7 1 Tf 3.192 0 TD -0.0068 Tc 0 Tw (df)Tj /TT2 1 Tf 0.768 0 TD -0.0025 Tc -0.035 Tw [( =1, )]TJ /TT7 1 Tf 1.737 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.003 Tc -0.04 Tw [( <.05\).)]TJ -14.511 -2.001 TD 0.0007 Tc 0.125 Tw [(T)71.5(able 3 presents a comparison of the repetitively as-)]TJ -1.8 -1.398 TD -0.0027 Tc -0.0309 Tw (saultive patients in this data base at 10 years and at 15 years.)Tj 0 -1.401 TD -0.003 Tc -0.0127 Tw [(\(Clinical variables are for the years 1994-2005.\) They were)]TJ T* -0.0036 Tc -0.0237 Tw (older patients with a diagnosis of schizophrenia or personal-)Tj 0 -1.398 TD -0.0033 Tc -0.0431 Tw (ity disorder and histories of violence toward others, personal)Tj 0 -1.401 TD -0.0082 Tc -0.0619 Tw [(victimization, and substance used disorder)51.8(. )52(Additional analy-)]TJ T* -0.0032 Tc 0.023 Tw (ses comparing these repeat offenders at 10 and 15 years re-)Tj 0 -1.398 TD 0.0357 Tw (vealed a statistically significant difference for diagnosis \()Tj /TT7 1 Tf 22.971 0 TD 0 Tc 0 Tw (x)Tj /TT2 1 Tf 5.8 0 0 5.8 555.09 99.3 Tm (2)Tj 10 0 0 10 321 88.65 Tm -0.02 Tc (=11.86, )Tj /TT7 1 Tf 3.099 0 TD -0.0278 Tc (df)Tj /TT2 1 Tf 0.735 0 TD -0.018 Tc -0.06 Tw [( = 4, )]TJ /TT7 1 Tf 1.776 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.48 0 TD -0.0203 Tc -0.065 Tw [( <.02\).)]TJ ET endstream endobj 63 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 65 0 obj << /Length 5457 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0046 Tc 0.1125 Tw [(4 )]TJ /TT3 1 Tf 1.7138 0 TD -0.0054 Tc [(Flannery and Walker Repetitively Assaultive Psychiatric Patients)]TJ /F1 1 Tf 10 0 0 10 282.51 723 Tm -0.0063 Tc -0.02 Tw [(T)79.7(a)5.7(b)5.7(le 1)]TJ /TT3 1 Tf -18.336 -1.2 TD -0.0047 Tc -0.0475 Tw (Demographic Characteristics of Repetitively/Non-repetitively Assaultive Patients, 1990-2005)Tj /F19 1 Tf 10 0 2.1256 10 78 687 Tm -0.0122 Tc 0 Tw [(P)39.8(atient)]TJ 16.8 0 TD -0.0062 Tc (Repetitively)Tj 19.2 0 TD -0.014 Tc (Non-Repetitively)Tj -35.7449 -1.2 TD 0.0019 Tc [(V)92.9(a)26.9(ri)23.9(a)23.9(b)37.9(l)23.9(e)-13348.1(Assaultive)-14623.1(Assaultive)]TJ 0.5101 -2.4 TD -0.027 Tc (Age)Tj /TT3 1 Tf 10 0 0 10 246 651 Tm -0.0238 Tc [(35.5)-17348.8(35.8)]TJ 0 -1.2 TD 0 Tc (\()Tj /F19 1 Tf 10 0 2.1256 10 249.3 639 Tm -0.015 Tc (SD)Tj /TT3 1 Tf 10 0 0 10 263.04 639 Tm -0.0047 Tc -0.0325 Tw [( = 11.9\))-14179.7(\()]TJ /F19 1 Tf 10 0 2.1256 10 441.3 639 Tm -0.015 Tc 0 Tw (SD)Tj /TT3 1 Tf 10 0 0 10 455.04 639 Tm -0.0047 Tc -0.0325 Tw [( = 11.9\))]TJ /F19 1 Tf 10 0 2.1256 10 78 627 Tm -0.037 Tc 0 Tw (Gender)Tj /TT3 1 Tf 10 0 0 10 78 615 Tm -0.0225 Tc -0.0282 Tw [(Male)-14722.5(7)-16.8(3)-16.8( )]TJ 18.3552 0 TD -0.0057 Tc -0.0575 Tw [(\(47%\))-15005.7(582 \(52%\))]TJ -18.3552 -1.2 TD -0.0219 Tc -0.0288 Tw [(Female)-13596.9(8)-16.2(1)-16.2( )]TJ 18.3552 0 TD -0.0057 Tc -0.0575 Tw [(\(52%\))-15005.7(533 \(47%\))]TJ /F19 1 Tf 10 0 2.1256 10 78 579 Tm -0.0144 Tc 0 Tw (Diagnosis)Tj /TT3 1 Tf 10 0 0 10 78 567 Tm -0.0156 Tc (Schizophrenia)Tj 16.8 0 TD -0.0057 Tc -0.045 Tw [(85 \(55%\))-15005.7(523 )12.5( )12.5(\(46%\))]TJ -16.8 -1.2 TD -0.0052 Tc -0.0455 Tw [(Affective )-35.9(Disorder)-9005.2(21 \(14%\))-15005.2(207 )12.5( )12.5(\(18%\))]TJ T* -0.0071 Tc -0.0436 Tw [(Personality )27.6(Disorder)-8032.1(27 \(17%\))-15007.1(215 )12.5( )12.5(\(19%\))]TJ T* -0.0252 Tc -0.0255 Tw [(Other)-14425.2(2)-19.5(2)-19.5( )]TJ 18.3552 0 TD -0.0057 Tc -0.0575 Tw [(\(14%\))-15005.7(186 \(16%\))]TJ /F19 1 Tf 10 0 2.1256 10 78 507 Tm 0.0007 Tc 0 Tw (Site)Tj /TT3 1 Tf 10 0 0 10 78 495 Tm -0.0054 Tc -0.0578 Tw [(State )-48.2(Hospital)-10655.4(115 \(74%\))-14480.4(827 \(73%\))]TJ 0 -1.2 TD -0.0113 Tc -0.0038 Tw [(Community)-11861.3( 40 )]TJ 18.953 0 TD -0.0055 Tc -0.0577 Tw [(\(26%\))-14405.5(304 \(27%\))]TJ /F19 1 Tf 10 0 2.1256 10 78 459 Tm -0.0046 Tc -0.0329 Tw (No significant differences were obtained for any variables.)Tj ET 0.99 w 1000 M /GS1 gs 55.495 698.505 489.01 -221.01 re S BT /F1 1 Tf 10 0 0 10 283.74 393.99 Tm /GS2 gs -0.007 Tc -0.0193 Tw [(T)79(a)5(ble 2)]TJ /TT3 1 Tf -15.333 -1.2 TD -0.0046 Tc -0.025 Tw (Characteristics of Repetitively/Non-repetitively Assaultive Patients, 1994-2005)Tj /F19 1 Tf 10 0 2.1256 10 79.5 357.99 Tm -0.0122 Tc 0 Tw [(P)39.8(atient)]TJ 11.901 0 TD -0.0062 Tc (Repetitively)Tj 16.698 0 TD -0.014 Tc [(Non-Repetitively)-3890(p)]TJ -28.3439 -1.2 TD 0.0019 Tc [(V)92.9(a)26.9(ri)23.9(a)23.9(b)37.9(l)23.9(e)-8449.1(Assaultive)-12121.1(Assaultive)]TJ 0.5101 -2.4 TD -0.027 Tc (Age)Tj /TT3 1 Tf 10 0 0 10 198.51 321.99 Tm -0.0256 Tc [(36.10)-14323.6(35.37)-8626.6(n)-19.5(s)]TJ 0 -1.2 TD 0 Tc (\()Tj /F19 1 Tf 10 0 2.1256 10 201.81 309.99 Tm -0.0085 Tc (SD )Tj /TT3 1 Tf 10 0 0 10 217.86 309.99 Tm -0.0053 Tc -0.045 Tw [(= 12.98\))-11153.3(\()]TJ /F19 1 Tf 10 0 2.1256 10 368.79 309.99 Tm -0.015 Tc 0 Tw (SD)Tj /TT3 1 Tf 10 0 0 10 382.56 309.99 Tm -0.0049 Tc -0.045 Tw [( = 11.97\))]TJ /F19 1 Tf 10 0 2.1256 10 79.5 285.99 Tm -0.037 Tc 0 Tw (Gender)Tj /TT3 1 Tf 10 0 0 10 79.5 273.99 Tm -0.0225 Tc -0.0282 Tw [(Male)-9823.5(5)-16.8(5)-16.8( )]TJ 13.4562 0 TD -0.0058 Tc -0.0574 Tw [(\(45%\))-12503.8(519 \(50%\))-6281.8(ns)]TJ -13.4562 -1.2 TD -0.0219 Tc -0.0288 Tw [(Female)-8697.9(6)-16.2(7)-16.2( )]TJ 13.4562 0 TD -0.0057 Tc -0.0575 Tw [(\(55%\))-12503.7(499 \(48%\))]TJ /F19 1 Tf 10 0 2.1256 10 79.5 237.99 Tm -0.0144 Tc 0 Tw (Diagnosis)Tj /TT3 1 Tf 10 0 0 10 79.5 225.99 Tm -0.0156 Tc (Schizophrenia)Tj 11.901 0 TD -0.0057 Tc -0.045 Tw [(63 \(51%\))-12503.7(484 )12.5( )12.5(\(47%\))-6281.7(ns)]TJ -11.901 -1.2 TD -0.0052 Tc -0.0455 Tw [(Affective )-35.9(Disorder)-4106.2(19 \(16%\))-12503.2(207 )12.5( )12.5(\(19%\))]TJ T* -0.0071 Tc -0.0436 Tw [(Personality )27.6(Disorder)-3133.1(27 \(22%\))-12505.1(212 )12.5( )12.5(\(21%\))]TJ T* -0.0252 Tc -0.0255 Tw [(Other)-9526.2(1)-19.5(4)-19.5( )]TJ 13.4562 0 TD -0.0057 Tc -0.0575 Tw [(\(14%\))-12503.7(139 \(13%\))]TJ /F19 1 Tf 10 0 2.1256 10 79.5 165.99 Tm -0.0045 Tc 0.0072 Tw [(Histor)-34.5(y of )46.9(Violence )]TJ /TT3 1 Tf 10 0 0 10 195.75 165.99 Tm -0.0059 Tc -0.0573 Tw [(121 )-67.1(\(98%\))-12404.9(948 \(92%\))-6281.9(.)14.2(0)14.2(1)]TJ /F19 1 Tf 10 0 2.1256 10 79.5 153.99 Tm -0.0138 Tc -0.07 Tw [(T)123.2(o)11.2(w)18.2(ard Others)]TJ 0.5101 -2.4 TD -0.0035 Tc 0.0152 Tw [(P)54.5(ersonal )]TJ /TT3 1 Tf 10 0 0 10 196.41 129.99 Tm -0.006 Tc -0.0572 Tw [(101 )-77(\(82%\))-12330(670 \(65%\))-6282(.)14.1(0)14.1(1)]TJ /F19 1 Tf 10 0 2.1256 10 79.5 117.99 Tm 0.0011 Tc 0 Tw (Victimization)Tj 0.5101 -2.4 TD -0.0094 Tc (Substance)Tj /TT3 1 Tf 10 0 0 10 198.51 93.99 Tm -0.0057 Tc -0.045 Tw [(86 \( 70%\))-12503.7(574 )12.5( )12.5(\(56%\))-6281.7(.)14.4(0)14.4(5)]TJ /F19 1 Tf 10 0 2.1256 10 79.5 81.99 Tm -0.0126 Tc -0.07 Tw (Use Disorder)Tj ET /GS1 gs 54.495 375.505 490.01 -302.01 re S endstream endobj 66 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F19 67 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 69 0 obj << /Length 7018 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 431.91 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD 0 Tc 0 Tw (5)Tj /TT2 1 Tf 10 0 0 10 83.01 375.15 Tm -0.0033 Tc -0.0241 Tw (A per capita rate of assault has not been included in this)Tj -1.8 -1.401 TD -0.0026 Tc -0.0054 Tw [(study)63.4(. During the 15 years of the study)60.4(, several of its facili-)]TJ 0 -1.398 TD -0.0034 Tc 0.0268 Tw [(ties were downsized, closed, and/or privatized. Patient and)]TJ 0 -1.401 TD -0.003 Tc 0.0344 Tw (staff ratios changed repeatedly during these years such that)Tj T* -0.0031 Tc 0.0082 Tw (a per capita rate of assault for the entire study period would)Tj 0 -1.398 TD -0.0028 Tc 0.035 Tw (be statistically inaccurate.)Tj /F1 1 Tf 11 0 0 11 148.26 272.49 Tm 0.0207 Tc 0 Tw (DISCUSSION)Tj /TT2 1 Tf 10 0 0 10 83.01 249.15 Tm -0.0024 Tc 0.1249 Tw [(This study)54.6(s findings constitute the longest published)]TJ -1.8 -1.401 TD -0.001 Tc 0.125 Tw (study of repeat offenders to date and partially support its)Tj 0 -1.398 TD -0.0031 Tc -0.045 Tw [(hypotheses. The findings confirmed its first hypothesis with)]TJ 0 -1.401 TD -0.0036 Tc -0.0343 Tw [(regard to the demographic variables. Repeat assailants were)]TJ T* -0.0034 Tc -0.0256 Tw (older male or female patients with schizophrenia or younger)Tj 0 -1.398 TD 0.0992 Tw (patients with personality disorders, and the preponderance)Tj 0 -1.401 TD 0.0089 Tc 0.125 Tw (of these assaults continued to occur in hospital settings.)Tj T* -0.0008 Tc [(T)70(welve percent of the patients committed 31% of the as-)]TJ 0 -1.398 TD -0.0036 Tc 0.1169 Tw [(saults. This finding is consistent with previous published)]TJ 0 -1.401 TD -0.0034 Tc 0.0312 Tw (research for single incident assaults and repeat offender as-)Tj T* -0.0171 Tc -0.0623 Tw [(saults \(Flannery)63.9(, 2002; Flannery et al., 2002; Flannery)57.9(, Juliano,)]TJ 0 -1.398 TD -0.0034 Tc 0.0455 Tw [(et al., 2006; Grange & Corbett, 2002\). There were modest)]TJ 0 -1.401 TD -0.0032 Tc 0.05 Tw (increases in patients with affective disorders at the 15-year)Tj 25.599 29.4 TD 0.0161 Tw [(period. This may reflect an increased true incidence, better)]TJ 0 -1.401 TD -0.0034 Tc 0.0737 Tw (diagnosis, or an emphasis on the emerging hypothesis that)Tj 0 -1.398 TD 0.0536 Tw (schizophrenia and affective disorders may be two different)Tj 0 -1.401 TD -0.0025 Tc 0.125 Tw [(phenotypes of the same genotype. However)39.5(, none of the)]TJ T* -0.002 Tc (demographic variables suggested a predictive relationship)Tj 0 -1.398 TD 0.0039 Tc 0.1249 Tw (with subsequent assaults.)Tj 1.8 -2.001 TD -0.0012 Tc 0.125 Tw [(W)57.6(ith regard to the clinical variables, the study)52.8(s first)]TJ -1.8 -1.401 TD -0.0032 Tc 0.0233 Tw [(hypothesis was partially confirmed. Personal victimization)]TJ 0 -1.398 TD 0.0002 Tc 0.125 Tw (was associated with subsequent assault, but in this larger)Tj 0 -1.401 TD -0.0037 Tc 0.0381 Tw (sample so also were violence towards others and substance)Tj T* -0.0032 Tc 0.0467 Tw [(use disorder)50.8(.)-5.2( )54.5(A)59( previous study from this 15-year data base)]TJ 0 -1.398 TD -0.0034 Tc 0 Tw (that assessed the contributions of these three variables, both)Tj 0 -1.401 TD -0.0033 Tc -0.0625 Tw [(individually and in various combinations \(Flannery)59.7(, Hanson,)]TJ T* -0.0037 Tc 0.0801 Tw [(Corrigan, & )14.4(W)97.1(alker)35.3(, 2006\), demonstrated that violence to-)]TJ 0 -1.398 TD -0.0123 Tc -0.0625 Tw (ward others and personal victimization significantly increased)Tj 0 -1.401 TD -0.0003 Tc 0.1251 Tw [(the risk of association with subsequent assault. )17.8(V)67.9(iolence)]TJ T* -0.0046 Tc -0.0621 Tw (toward others, personal victimization, and substance use pre-)Tj 0 -1.398 TD -0.0033 Tc 0.0884 Tw [(sented the greatest risk. These three clinical variables ap-)]TJ 0 -1.401 TD -0.0036 Tc 0.0984 Tw (pear to be associated with subsequent assault.)Tj 1.8 -2.001 TD 0.001 Tc 0.1249 Tw [(This study)52(s consistent and stable findings of patient)]TJ -1.8 -1.398 TD -0.0052 Tc -0.0625 Tw (assault characteristics over a 15-year time span, coupled with)Tj /F1 1 Tf -1.974 64.035 TD -0.0063 Tc -0.02 Tw [(T)79.7(a)5.7(b)5.7(le 3)]TJ /TT3 1 Tf -14.811 -1.2 TD -0.0046 Tc 0.01 Tw (Characteristics of Repetitively Assaultive Patients at Ten and Fifteen Years)Tj /F19 1 Tf 10 0 2.1256 10 96.99 687.51 Tm -0.0118 Tc -0.1572 Tw [(P)40.2(atient)-11411.8(T)119.2(e)-0.5(nth Y)]TJ 17.406 0 TD -0.0068 Tc -0.1432 Tw [(ear)-9981.8(Fifteenth Y)138.2(ear)-4878.8(p)]TJ -17.1509 -1.2 TD -0.022 Tc 0 Tw [(V)69(a)3(r)-22(iab)11(le)]TJ 0.5101 -2.4 TD -0.027 Tc (Age)Tj /TT3 1 Tf 10 0 0 10 240.99 651.51 Tm -0.0248 Tc [(33.56)-12024.8(35.5)-8949.8(n)-18.6(s)]TJ 0 -1.2 TD 0 Tc (\()Tj /F19 1 Tf 10 0 2.1256 10 244.29 639.51 Tm -0.015 Tc (SD)Tj /TT3 1 Tf 10 0 0 10 258.06 639.51 Tm -0.0054 Tc -0.0026 Tw [( = 9.63\))-8777.4(\()]TJ /F19 1 Tf 10 0 2.1256 10 388.29 639.51 Tm -0.015 Tc 0 Tw (SD)Tj /TT3 1 Tf 10 0 0 10 402.06 639.51 Tm -0.0047 Tc -0.0325 Tw [( = 11.9\))]TJ /F19 1 Tf 10 0 2.1256 10 96.99 615.51 Tm -0.037 Tc 0 Tw (Gender)Tj /TT3 1 Tf 10 0 0 10 96.99 603.51 Tm -0.0225 Tc -0.0282 Tw [(Male)-12322.5(2)-16.8(6)-16.8( )]TJ 15.9552 0 TD -0.0058 Tc -0.0449 Tw [(\(42%\))-10205.8(73 \(47%\))-6605.8(ns)]TJ -15.9552 -1.2 TD -0.0219 Tc -0.0288 Tw [(Female)-11196.9(3)-16.2(5)-16.2( )]TJ 15.9552 0 TD -0.0057 Tc -0.045 Tw [(\(57%\))-10205.7(81 \(52%\))]TJ /F19 1 Tf 10 0 2.1256 10 96.99 567.51 Tm -0.0144 Tc 0 Tw (Diagnosis)Tj /TT3 1 Tf 10 0 0 10 96.99 555.51 Tm -0.0156 Tc (Schizophrenia)Tj 14.4 0 TD -0.0057 Tc -0.045 Tw [(35 \(57%\))-10205.7(85 \(55%\))-6605.7(.)14.4(0)14.4(2)]TJ -14.4 -1.2 TD -0.0049 Tc 0.0105 Tw [(Affective )20.4(Disorder)-6604.9( 3 \( 5%\))-10054.9(21 )56.3( )56.3(\(14%\))]TJ T* -0.0069 Tc 0.0125 Tw [(Personality )83.9(Disorder)-5631.9( 5 \( 8%\))-10056.9(27 )56.3( )56.3(\(17%\))]TJ T* -0.0252 Tc -0.0255 Tw [(Other)-12025.2(1)-19.5(8)-19.5( )]TJ 15.9552 0 TD -0.0057 Tc -0.045 Tw [(\(30%\))-10205.7(22 \(14%\))]TJ /F19 1 Tf 10 0 2.1256 10 96.99 495.51 Tm -0.0053 Tc -0.0272 Tw [(Histor)-35.3(y of )46(Violence)]TJ /TT3 1 Tf 10 0 0 10 240.99 495.51 Tm -0.0125 Tc 0.0207 Tw [(30 )90.7(\(97%\))-6912.5( )]TJ 12.802 0 TD -0.0045 Tc 0.0127 Tw [( 121 \(98%\))-6379.5(ns)]TJ /F19 1 Tf 10 0 2.1256 10 96.99 483.51 Tm -0.0138 Tc -0.07 Tw [(T)120.2(o)14.2(w)18.2(ard Others)]TJ 0.5101 -2.4 TD -0.0205 Tc 0 Tw [(P)49.5(ersonal)]TJ /TT3 1 Tf 10 0 0 10 240.99 459.51 Tm -0.0125 Tc 0.0207 Tw [(29 )90.7(\(94%\))-6912.5( )]TJ 12.802 0 TD -0.0045 Tc 0.0127 Tw [( 101 \(82%\))-6379.5(ns)]TJ /F19 1 Tf 10 0 2.1256 10 96.99 447.51 Tm 0.0011 Tc 0 Tw (Victimization)Tj 0.5101 -2.4 TD -0.0094 Tc (Substance)Tj /TT3 1 Tf 10 0 0 10 240.99 423.51 Tm -0.0088 Tc -0.0419 Tw [(18 )31.8(\(58%\))-10508.8(86 \(70%\))-6608.8(ns)]TJ /F19 1 Tf 10 0 2.1256 10 96.99 411.51 Tm -0.0126 Tc -0.07 Tw (Use Disorder)Tj ET 0.99 w 1000 M /GS1 gs 66.495 704.505 490.01 -301.01 re S endstream endobj 70 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F19 67 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 72 0 obj << /Length 9247 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0046 Tc 0.1125 Tw [(6 )]TJ /TT3 1 Tf 1.7138 0 TD -0.0054 Tc [(Flannery and Walker Repetitively Assaultive Psychiatric Patients)]TJ /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0034 Tc 0.0037 Tw (clinical anecdotal evidence from the various facilities in the)Tj 0 -1.398 TD -0.0029 Tc 0.0531 Tw [(study confirm the study)54.1(s second hypothesis that the trans-)]TJ 0 -1.401 TD -0.0032 Tc 0.111 Tw (fer of correction patients to DMH did not yield an appre-)Tj T* -0.0442 Tw [(ciable risk of being repeat offenders in either the hospital or)]TJ 0 -1.398 TD -0.0035 Tc -0.0184 Tw [(community)59.5(. )17.8(There are several possible explanations for this)]TJ 0 -1.401 TD -0.0032 Tc 0.1016 Tw [(outcome. First, some of these patients should likely have)]TJ T* 0.005 Tc 0.125 Tw (been diverted to mental health services and not been di-)Tj 0 -1.398 TD -0.0031 Tc 0.0445 Tw [(verted to the corrections system to begin with. Second, all)]TJ 0 -1.401 TD -0.0037 Tc 0.0122 Tw (were assessed and stabilized in DOC and received a second)Tj T* -0.0033 Tc 0.0607 Tw (assessment with stabilization, if indicated, when they were)Tj 0 -1.398 TD 0.0078 Tc 0.125 Tw [(transferred to DMH. Third, the transferred patients had)]TJ 0 -1.401 TD -0.0033 Tc 0.0462 Tw (greater personal and physical freedom in DMH facilities, a)Tj T* 0.005 Tc 0.125 Tw [(factor which may have reduced frustration or irritability)59(.)]TJ 0 -1.398 TD -0.0024 Tc 0.1248 Tw [(Lastly)63.6(, these patients knew that transfer to DMH was the)]TJ 0 -1.401 TD -0.0029 Tc -0.0482 Tw (first step to returning to the community and it is unlikely that)Tj T* -0.0032 Tc -0.0113 Tw [(they would jeopardize this form of opportunity)59.8(. )54.2(Although it)]TJ 0 -1.398 TD -0.0034 Tc 0.0228 Tw (is possible that some may have engaged in verbal intimida-)Tj 0 -1.401 TD -0.003 Tc -0.0007 Tw (tion, no DMH facility reported such occurrences. Psychiat-)Tj T* -0.0538 Tw (ric patients, especially those with the three clinical variables,)Tj 0 -1.398 TD -0.0035 Tc -0.0359 Tw [(represent an ongoing risk for assault but there is no evidence)]TJ 0 -1.401 TD -0.0034 Tc 0.0793 Tw (at present that a corrections-transferred patient presents an)Tj T* -0.0039 Tc 0.075 Tw (undue heightened risk.)Tj 1.8 -1.998 TD -0.0029 Tc 0.0221 Tw [(Lastly)63.1(, the stability of repeat of)15.1(fender assailant charac-)]TJ -1.8 -1.401 TD -0.0035 Tc 0.0519 Tw (teristics over time presents an issue with important clinical)Tj T* -0.0041 Tc -0.0622 Tw [(and research implication. While medication, behavioral, and)]TJ 0 -1.398 TD -0.0033 Tc 0.0188 Tw (forensic consults may prove helpful in individual cases, the)Tj 0 -1.401 TD -0.003 Tc 0.0357 Tw (research findings suggest a certain intractability in modify-)Tj T* -0.0031 Tc 0.0099 Tw [(ing repeat of)17.9(fender assault risks. )17.8(This study)50.9(s findings may)]TJ 0 -1.398 TD -0.0034 Tc 0.1038 Tw (be masking an age maturation effect in that certain repeat)Tj 0 -1.401 TD 0.0951 Tw [(of)17.6(fenders become less assaultive with time. )50.7(As this study)]TJ T* -0.0056 Tc -0.0623 Tw (has continued to grow over time, it may have come to include)Tj 0 -1.398 TD -0.0036 Tc -0.0242 Tw [(newer)38.4(, often younger admissions with the same basic demo-)]TJ 0 -1.401 TD -0.0014 Tc 0.125 Tw (graphic and clinical characteristics as their older counter-)Tj T* -0.0038 Tc -0.0349 Tw [(parts. )50.3(Another possible explanation for consideration would)]TJ 0 -1.398 TD -0.0034 Tc 0.001 Tw (be that the assault violence in some cases may be stemming)Tj 0 -1.401 TD -0.0035 Tc -0.0486 Tw (from a trauma-shaped neurobiology and that certain changes)Tj T* 0.1223 Tw (in the structure and functioning of brains of patients with)Tj 0 -1.398 TD -0.0033 Tc 0.0569 Tw (histories of personal victimization may increase the risk of)Tj 0 -1.401 TD -0.0117 Tc -0.0623 Tw [(irritability and subsequent assault \(T)69.3(eicher)36.3(, )48.5(Andersen, Polcari,)]TJ T* -0.0034 Tc -0.03 Tw [(Andersen, & Navalta, 2002\). Hypotheses such as these sug-)]TJ 0 -1.398 TD -0.0035 Tc -0.0085 Tw (gest that patient assaults are complex person x event x envi-)Tj 0 -1.401 TD 0.0656 Tw (ronment interactions and point to the need for longitudinal)Tj T* 0.0043 Tc 0.125 Tw (prospective studies that include event and environmental)Tj 0 -1.398 TD -0.0066 Tc -0.0625 Tw (variables in addition to demographic and clinical person vari-)Tj 0 -1.401 TD -0.0034 Tc 0.0765 Tw [(ables. These findings also suggest the need for those pro-)]TJ T* -0.0035 Tc -0.0031 Tw (viding clinical care to repeat successful interventions with a)Tj 0 -1.398 TD -0.0034 Tc 0.0367 Tw (repeat offender with other similar repeat offenders to see if)Tj 25.5 64.998 TD -0.0035 Tc -0.0277 Tw [(there are decreased assaults in these subsequent cases. Such)]TJ 0 -1.398 TD -0.0034 Tc 0.1165 Tw (case studies may provide helpful assistance in delineating)Tj 0 -1.401 TD 0.0167 Tc 0.125 Tw (the key variables associated with repeated assaults that)Tj T* -0.0035 Tc 0.0136 Tw (should be investigated in larger empirical research studies.)Tj /F1 1 Tf 11 0 0 11 309 648 Tm -0.0046 Tc 0.0348 Tw (Implications for Emergency Services)Tj /TT7 1 Tf 0 -1.5136 TD 0.0148 Tc 0.1272 Tw [(P)5.7(r)33.9(e-Incident T)50.3(r)0.2(aining)]TJ /TT2 1 Tf 10 0 0 10 327 611.64 Tm -0.0033 Tc 0.1064 Tw (As has been noted above, psychiatric patients present)Tj -1.8 -1.398 TD -0.0034 Tc -0.0515 Tw (an ongoing risk to EMS personnel. There are several ways to)Tj 0 -1.401 TD 0.038 Tw [(address this issue. The first approach is through the devel-)]TJ T* -0.0037 Tc 0.0458 Tw (opment of sound pre-incident policies and procedures.)Tj 1.8 -1.998 TD -0.0034 Tc 0.0425 Tw (A beginning step is to establish a detailed data base of)Tj -1.8 -1.401 TD -0.0032 Tc 0.082 Tw [(those calls that result in assault incidents. The greater the)]TJ T* -0.0031 Tw (collection of details for the data base, the greater will be the)Tj 0 -1.398 TD -0.0028 Tc -0.009 Tw [(ability to identify possible risk. Included below is a statisti-)]TJ 0 -1.401 TD -0.0029 Tc -0.0532 Tw (cal summary of the high risk factors in this present study that)Tj T* -0.0034 Tc -0.0216 Tw [(have been reported in several earlier publications. This data)]TJ 0 -1.398 TD -0.005 Tc -0.0625 Tw (summary covers the years 1990-2005 and illustrates the level)Tj 0 -1.401 TD -0.0033 Tc 0.024 Tw (of detail that can be gathered.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0043 Tc -0.0717 Tw (Inpatient Assaults)Tj /TT1 1 Tf 7.05 0 TD 0 Tc 0 Tw (:)Tj /TT2 1 Tf 0.33 0 TD -0.0037 Tc -0.0543 Tw [( S)21.5(taf)17.3(f most at risk continue to be new)59.3(,)]TJ -9.18 -1.398 TD -0.0074 Tc -0.0625 Tw (less experienced, less formally-trained mental health workers)Tj 0 -1.401 TD -0.003 Tc 0.125 Tw (and nurses during restraint and seclusion procedures. The)Tj T* -0.0031 Tc -0.0018 Tw (assaultive patient is most likely to be of the same gender; to)Tj 0 -1.398 TD -0.004 Tc -0.0625 Tw (have a primary diagnosis of schizophrenia or personality dis-)Tj 0 -1.401 TD -0.0034 Tc 0.0333 Tw (order; to have past histories of violence toward others, per-)Tj T* -0.0035 Tc 0.0395 Tw (sonal victimization, substance use disorder; and to not be a)Tj 0 -1.398 TD -0.0031 Tc 0.0495 Tw [(repeat of)17.9(fender)50.9(. )15(The most likely precipitants are acute psy-)]TJ 0 -1.401 TD 0.0014 Tc 0.125 Tw (chosis, denial of services, and/or excess sensory stimula-)Tj T* -0.0031 Tc -0.0196 Tw (tion. Such assaults are most likely to occur in the middle ten)Tj 0 -1.398 TD -0.0035 Tc -0.0412 Tw [(days of the month on the first shift from 7:00-9:00 )50.8(AM.)]TJ /TT7 1 Tf 1.8 -2.001 TD -0.005 Tc -0.079 Tw (Community Assaults)Tj /TT1 1 Tf 8.031 0 TD 0 Tc 0 Tw (:)Tj /TT2 1 Tf 0.33 0 TD -0.0042 Tc -0.0624 Tw [( )-5.6(S)21(taf)16.8(f most at risk include new)58.8(, less)]TJ -10.161 -1.401 TD -0.0092 Tc -0.0621 Tw (experienced mental health workers and residential house staff)Tj 0 -1.398 TD -0.0036 Tc 0.1222 Tw (and nurses during restraint procedures. The assaultive pa-)Tj 0 -1.401 TD -0.0081 Tc -0.0623 Tw (tient is most likely to be of the same gender; to have a primary)Tj T* -0.0034 Tc 0.0693 Tw (diagnosis of schizophrenia or personality disorder; to have)Tj 0 -1.398 TD -0.0035 Tc 0.0043 Tw (past histories of violence toward others, personal victimiza-)Tj 0 -1.401 TD 0.0108 Tc 0.125 Tw (tion, and substance use disorder; and to not be a repeat)Tj T* -0.0033 Tc 0.0532 Tw [(of)17.7(fender)50.7(. )15.4(The most likely precipitants are acute psychosis,)]TJ 0 -1.398 TD 0.0607 Tw (denial of services, and/or excess sensory stimulation. Such)Tj 0 -1.401 TD -0.0027 Tc -0.0217 Tw (assaults are likely to occur in the first ten days of the month.)Tj T* -0.0069 Tc -0.0625 Tw (In community residences, the most likely time of assault is on)Tj 0 -1.398 TD -0.0039 Tc -0.058 Tw (the second shift between 10:00-11:00 PM.)Tj 1.8 -2.001 TD -0.0034 Tc 0.0044 Tw (This level of detail was captured on a two-sided, single)Tj -1.8 -1.401 TD -0.0035 Tc 0.0519 Tw [(page that could be completed in less than five minutes and)]TJ 0 -1.398 TD 0.0762 Tw (then entered as individual units into a computer data base.)Tj ET endstream endobj 73 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 75 0 obj << /Length 9319 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 431.91 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD 0 Tc 0 Tw (7)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0083 Tc -0.0621 Tw (EMS organizations can similarly gather assault incident char-)Tj 0 -1.398 TD -0.003 Tc -0.0605 Tw [(acteristics ef)18(ficiently)60(.)]TJ 1.8 -2.001 TD -0.0034 Tc 0.0431 Tw (In addition to the data base, good pre-incident training)Tj -1.8 -1.401 TD 0.0044 Tw (should include policies and training in some system of non-)Tj 0 -1.398 TD 0.0037 Tc 0.125 Tw (violent self-defense, restraint procedures, communication)Tj 0 -1.401 TD -0.0033 Tc 0.0867 Tw (skills with patients, and a knowledge of the early warning)Tj T* -0.0034 Tc -0.0212 Tw [(signs of impending loss of patient control \(Flannery)59.6(, 1998\).)]TJ /TT7 1 Tf 11 0 0 11 66 599.34 Tm 0.011 Tc 0.1251 Tw [(Onsite Incident Pr)32.8(ovision of Services)]TJ /TT2 1 Tf 10 0 0 10 84 579.66 Tm -0.0038 Tc 0.0045 Tw (As an EMS crew is dispatched, its members should be-)Tj -1.8 -1.401 TD -0.0036 Tc 0.019 Tw (gin to gather as much information as possible about the po-)Tj T* 0.0091 Tc 0.125 Tw [(tential for violence at the scene. What is known of the)]TJ 0 -1.398 TD -0.0031 Tc 0.0607 Tw [(patient)50.9(s past history of violence? Does the patient have a)]TJ 0 -1.401 TD 0.0006 Tw (diagnosis of schizophrenia or personality disorder? Is there)Tj T* -0.0027 Tc -0.0391 Tw [(a history of personal victimization? Is there also a history of)]TJ 0 -1.398 TD -0.0034 Tc 0.125 Tw [(substance use disorder? Knowing this information in ad-)]TJ 0 -1.401 TD -0.0036 Tc 0.0135 Tw [(vance from the team)50.4(s data base or from current care givers)]TJ T* -0.0028 Tc -0.0013 Tw (can help to assess any initial level of risk.)Tj 1.8 -1.998 TD -0.0034 Tc -0.019 Tw (When arriving onsite, survey the )Tj /TT7 1 Tf 13.125 0 TD -0.0054 Tc 0 Tw (scene)Tj /TT2 1 Tf 2.199 0 TD -0.0022 Tc -0.02 Tw [( first. Does any-)]TJ -17.124 -1.401 TD -0.0029 Tc 0.0994 Tw [(thing appear menacing? Why are people where they are?)]TJ T* -0.003 Tc 0.0573 Tw [(Are there any potential weapons in sight? If the scene ap-)]TJ 0 -1.398 TD -0.0032 Tc -0.0622 Tw [(pears relatively safe, proceed to the identified patient. Moni-)]TJ 0 -1.401 TD -0.003 Tc 0.0054 Tw (tor the patient for the early warning signs of loss of control.)Tj T* -0.0035 Tc 0.0189 Tw [(If the crew has no information on the patient)53.5(s violence po-)]TJ 0 -1.398 TD -0.0034 Tc 0.035 Tw (tential, ask about past violence, personal victimization, and)Tj 0 -1.401 TD -0.0032 Tc 0.056 Tw (substance use as part of a routine history taking to provide)Tj T* -0.0036 Tc -0.0625 Tw [(better prehospital care. Borum, Swartz, and Swanson \(1996\))]TJ 0 -1.398 TD -0.0033 Tc -0.0433 Tw (have created a list of excellent, brief, screening questions for)Tj 0 -1.401 TD -0.0036 Tc 0.0699 Tw [(violence, such as having trouble with one)50.4(s temper)38.4(, hitting)]TJ T* -0.003 Tc 0.0359 Tw [(others when angry)60(, etc. If the patient is in tenuous control,)]TJ 0 -1.398 TD -0.0035 Tc 0.0411 Tw (always have one member of the team monitoring the scene)Tj 0 -1.401 TD -0.0034 Tc 0.0513 Tw (and the patient as the partner provides needed care.)Tj /TT7 1 Tf 11 0 0 11 66 232.35 Tm 0.0197 Tc 0.1272 Tw (Post-Incident Response)Tj /TT2 1 Tf 10 0 0 10 84 212.64 Tm -0.0037 Tc 0.04 Tw [(As the present research findings demonstrate, violence)]TJ -1.8 -1.398 TD -0.0033 Tc 0.031 Tw [(may occur in spite of the best precautions. EMS personnel)]TJ 0 -1.401 TD -0.0024 Tc -0.0575 Tw (may be physically injured and/or psychologically distressed.)Tj T* -0.0039 Tc -0.0622 Tw (In the latter circumstances, all EMS personnel should be rou-)Tj 0 -1.398 TD -0.0033 Tc -0.025 Tw (tinely offered crisis intervention procedures to address emo-)Tj 0 -1.401 TD -0.0034 Tc -0.0217 Tw [(tional responses to the incident. The Critical Incident Stress)]TJ T* -0.0059 Tc -0.0625 Tw (Management system \(CISM; Everly & Mitchell, 1999\) or the)Tj 0 -1.398 TD -0.0104 Tc -0.0617 Tw [(ASAP)31.6( program \(Flannery)64.6(, 1998\) )]TJ 12.7602 0 TD -0.0096 Tc -0.0625 Tw (are two approaches that may)Tj -12.7602 -1.401 TD -0.0036 Tc 0.0238 Tw (be helpful in these circumstances.)Tj 27.3 62.199 TD -0.0494 Tw (This risk of patient violence during prehospital care will)Tj -1.8 -1.398 TD -0.0037 Tc -0.0368 Tw [(often be present. However)35.3(, with adequate preparation, EMS)]TJ 0 -1.401 TD -0.0034 Tc -0.0455 Tw (personnel will be able to control much of this risk as hospital)Tj T* -0.0039 Tc 0.0234 Tw [(personnel with the same tools do now)59.1(.)]TJ /F1 1 Tf 11 0 0 11 400.89 648 Tm 0.021 Tc 0 Tw (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 321 630.66 Tm -0.0036 Tc -0.0604 Tw [(Borum, R., Swartz, M., & Swanson, J. \(1966\). )50.6(Assessing and)]TJ 1.2 -1.401 TD -0.0034 Tc 0.1046 Tw (managing violence risk in clinical practice. )Tj /TT7 1 Tf 18.294 0 TD -0.0042 Tc 0.105 Tw (Journal of)Tj -18.294 -1.401 TD -0.0039 Tc 0.0434 Tw [(Practical Psychology and Behavioral Health, July)53.1(,)-6.6( )]TJ /TT2 1 Tf 20.685 0 TD -0.006 Tc 0 Tw (205-)Tj -20.685 -1.398 TD -0.0583 Tc (215.)Tj -1.2 -1.8 TD -0.0035 Tc -0.0622 Tw [(Cheney)62.5(, R.R., Gossett, L., Fullerton-Gleason, L., )14.4(W)97.3(eiss, S.J.,)]TJ 1.2 -1.401 TD 0.0049 Tw [(Ernst, )51.2(A.A., & Sklar)35.5(, D. \(2006\). 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294.687 l 455.188 292.605 l 453.727 292.605 l f* 457.659 295.392 m 457.023 295.392 l 457.023 290.661 l 460.044 290.661 l 460.044 291.228 l 457.659 291.228 l 457.659 295.392 l f* 431.219 282.737 0.636 4.732 re f* 436.002 283.647 m 435.989 283.647 l 433.636 287.469 l 432.883 287.469 l 432.883 282.738 l 433.499 282.738 l 433.499 286.559 l 433.512 286.559 l 435.904 282.738 l 436.618 282.738 l 436.618 287.469 l 436.002 287.469 l 436.002 283.647 l f* 441.382 286.045 m 441.29 286.836 440.661 287.594 439.449 287.594 c 438.079 287.594 437.254 286.586 437.254 285.13 c 437.254 283.311 438.302 282.612 439.37 282.612 c 439.724 282.612 441.166 282.691 441.428 284.477 c 440.812 284.477 l 440.596 283.377 439.881 283.179 439.469 283.179 c 438.302 283.179 437.909 284.036 437.909 285.149 c 437.909 286.395 438.597 287.027 439.449 287.027 c 439.901 287.027 440.589 286.876 440.766 286.045 c 441.382 286.045 l f* 442.142 282.737 0.636 4.732 re f* 443.839 282.738 m 445.72 282.738 l 447.266 282.738 447.725 284.108 447.725 285.169 c 447.725 286.533 446.971 287.469 445.746 287.469 c 443.839 287.469 l 443.839 282.738 l h 444.475 286.922 m 445.661 286.922 l 446.526 286.922 447.07 286.322 447.07 285.13 c 447.07 283.937 446.532 283.285 445.707 283.285 c 444.475 283.285 l 444.475 286.922 l f* 451.925 283.305 m 449.088 283.305 l 449.088 284.886 l 451.663 284.886 l 451.663 285.452 l 449.088 285.452 l 449.088 286.902 l 451.879 286.902 l 451.879 287.469 l 448.452 287.469 l 448.452 282.738 l 451.925 282.738 l 451.925 283.305 l f* 455.739 283.647 m 455.726 283.647 l 453.373 287.469 l 452.62 287.469 l 452.62 282.738 l 453.236 282.738 l 453.236 286.559 l 453.249 286.559 l 455.641 282.738 l 456.355 282.738 l 456.355 287.469 l 455.739 287.469 l 455.739 283.647 l f* 456.794 286.902 m 458.386 286.902 l 458.386 282.737 l 459.022 282.737 l 459.022 286.902 l 460.614 286.902 l 460.614 287.469 l 456.794 287.469 l 456.794 286.902 l f* 436.837 278.161 m 436.811 278.682 436.647 279.67 435.003 279.67 c 433.862 279.67 433.384 278.945 433.384 278.208 c 433.384 277.384 434.079 277.167 434.387 277.094 c 435.35 276.87 l 436.123 276.686 436.352 276.528 436.352 276.033 c 436.352 275.355 435.579 275.236 435.121 275.236 c 434.518 275.236 433.823 275.486 433.823 276.343 c 433.227 276.343 l 433.227 275.902 433.305 275.506 433.705 275.144 c 433.915 274.953 434.256 274.688 435.127 274.688 c 435.933 274.688 436.968 274.999 436.968 276.119 c 436.968 276.87 436.51 277.239 435.9 277.384 c 434.557 277.694 l 434.282 277.76 434 277.892 434 278.293 c 434 279.011 434.675 279.123 435.075 279.123 c 435.606 279.123 436.208 278.893 436.241 278.161 c 436.837 278.161 l f* 437.231 278.978 m 438.823 278.978 l 438.823 274.814 l 439.458 274.814 l 439.458 278.978 l 441.051 278.978 l 441.051 279.545 l 437.231 279.545 l 437.231 278.978 l f* 442.23 276.844 m 443.77 276.844 l 444.53 276.844 444.609 276.389 444.609 276 c 444.609 275.822 444.629 275.105 444.72 274.815 c 445.5 274.815 l 445.5 274.92 l 445.304 275.032 445.271 275.131 445.264 275.394 c 445.225 276.251 l 445.199 276.91 444.93 277.028 444.661 277.14 c 444.963 277.318 445.317 277.575 445.317 278.273 c 445.317 279.275 444.543 279.545 443.77 279.545 c 441.595 279.545 l 441.595 274.815 l 442.23 274.815 l 442.23 276.844 l h 442.23 278.998 m 443.816 278.998 l 444.131 278.998 444.661 278.939 444.661 278.208 c 444.661 277.509 444.17 277.391 443.705 277.391 c 442.23 277.391 l 442.23 278.998 l f* 449.635 275.381 m 446.798 275.381 l 446.798 276.962 l 449.373 276.962 l 449.373 277.529 l 446.798 277.529 l 446.798 278.978 l 449.589 278.978 l 449.589 279.545 l 446.162 279.545 l 446.162 274.815 l 449.635 274.815 l 449.635 275.381 l f* 453.763 278.161 m 453.737 278.682 453.573 279.67 451.928 279.67 c 450.788 279.67 450.31 278.945 450.31 278.208 c 450.31 277.384 451.005 277.167 451.313 277.094 c 452.276 276.87 l 453.049 276.686 453.278 276.528 453.278 276.033 c 453.278 275.355 452.505 275.236 452.046 275.236 c 451.443 275.236 450.749 275.486 450.749 276.343 c 450.153 276.343 l 450.153 275.902 450.231 275.506 450.631 275.144 c 450.841 274.953 451.182 274.688 452.053 274.688 c 452.859 274.688 453.895 274.999 453.895 276.119 c 453.895 276.87 453.436 277.239 452.826 277.384 c 451.483 277.694 l 451.208 277.76 450.926 277.892 450.926 278.293 c 450.926 279.011 451.601 279.123 452.001 279.123 c 452.531 279.123 453.134 278.893 453.167 278.161 c 453.763 278.161 l f* 457.997 278.161 m 457.97 278.682 457.806 279.67 456.162 279.67 c 455.021 279.67 454.543 278.945 454.543 278.208 c 454.543 277.384 455.238 277.167 455.546 277.094 c 456.509 276.87 l 457.282 276.686 457.511 276.528 457.511 276.033 c 457.511 275.355 456.738 275.236 456.28 275.236 c 455.677 275.236 454.982 275.486 454.982 276.343 c 454.386 276.343 l 454.386 275.902 454.465 275.506 454.864 275.144 c 455.074 274.953 455.415 274.688 456.286 274.688 c 457.092 274.688 458.128 274.999 458.128 276.119 c 458.128 276.87 457.669 277.239 457.06 277.384 c 455.716 277.694 l 455.441 277.76 455.159 277.892 455.159 278.293 c 455.159 279.011 455.834 279.123 456.234 279.123 c 456.765 279.123 457.367 278.893 457.4 278.161 c 457.997 278.161 l f* 426.346 269.039 m 428.653 269.039 l 428.653 269.606 l 426.346 269.606 l 426.346 271.055 l 428.968 271.055 l 428.968 271.622 l 425.711 271.622 l 425.711 266.89 l 426.346 266.89 l 426.346 269.039 l f* 433.214 269.257 m 433.214 268.143 432.598 267.332 431.576 267.332 c 430.553 267.332 429.937 268.143 429.937 269.257 c 429.937 270.37 430.553 271.18 431.576 271.18 c 432.598 271.18 433.214 270.37 433.214 269.257 c h 433.869 269.257 m 433.869 270.278 433.332 271.747 431.576 271.747 c 429.819 271.747 429.282 270.278 429.282 269.257 c 429.282 268.235 429.819 266.765 431.576 266.765 c 433.332 266.765 433.869 268.235 433.869 269.257 c f* 437.552 271.622 m 437.552 268.631 l 437.552 267.603 436.896 267.332 436.313 267.332 c 435.743 267.332 435.121 267.616 435.121 268.644 c 435.121 271.622 l 434.485 271.622 l 434.485 268.466 l 434.485 267.583 435.029 266.765 436.294 266.765 c 437.584 266.765 438.187 267.583 438.187 268.551 c 438.187 271.622 l 437.552 271.622 l f* 442.165 267.8 m 442.152 267.8 l 439.799 271.622 l 439.046 271.622 l 439.046 266.891 l 439.662 266.891 l 439.662 270.713 l 439.675 270.713 l 442.067 266.891 l 442.781 266.891 l 442.781 271.622 l 442.165 271.622 l 442.165 267.8 l f* 443.659 266.891 m 445.54 266.891 l 447.086 266.891 447.545 268.262 447.545 269.322 c 447.545 270.686 446.791 271.622 445.566 271.622 c 443.659 271.622 l 443.659 266.891 l h 444.295 271.075 m 445.481 271.075 l 446.345 271.075 446.889 270.475 446.889 269.283 c 446.889 268.09 446.352 267.438 445.526 267.438 c 444.295 267.438 l 444.295 271.075 l f* 450.572 268.268 m 451.037 266.89 l 451.732 266.89 l 450.028 271.622 l 449.308 271.622 l 447.538 266.89 l 448.194 266.89 l 448.685 268.268 l 450.572 268.268 l h 448.882 268.835 m 449.635 270.917 l 449.648 270.917 l 450.343 268.835 l 448.882 268.835 l f* 450.985 271.055 m 452.577 271.055 l 452.577 266.89 l 453.213 266.89 l 453.213 271.055 l 454.805 271.055 l 454.805 271.622 l 450.985 271.622 l 450.985 271.055 l f* 455.369 266.89 0.636 4.732 re f* 460.722 269.257 m 460.722 268.143 460.106 267.332 459.084 267.332 c 458.062 267.332 457.446 268.143 457.446 269.257 c 457.446 270.37 458.062 271.18 459.084 271.18 c 460.106 271.18 460.722 270.37 460.722 269.257 c h 461.377 269.257 m 461.377 270.278 460.84 271.747 459.084 271.747 c 457.328 271.747 456.791 270.278 456.791 269.257 c 456.791 268.235 457.328 266.765 459.084 266.765 c 460.84 266.765 461.377 268.235 461.377 269.257 c f* 465.093 267.8 m 465.08 267.8 l 462.727 271.622 l 461.974 271.622 l 461.974 266.891 l 462.59 266.891 l 462.59 270.713 l 462.603 270.713 l 464.995 266.891 l 465.709 266.891 l 465.709 271.622 l 465.093 271.622 l 465.093 267.8 l f* q 0.9973 0 0 1.0027 0 0 cm 0.333 w 2.613 M 445.136 334.503 m 448.484 334.503 l 448.483 331.07 l 451.253 332.876 l 452.85 330.275 l 449.885 328.548 l 452.872 326.855 l 451.337 324.19 l 448.462 325.856 l 448.462 322.352 l 445.149 322.352 l 445.148 325.778 l 442.215 324.089 l 440.679 326.872 l 443.58 328.525 l 440.625 330.255 l 442.157 332.841 l 445.136 331.069 l 445.136 334.503 l b* Q 0 0 0 0 k 445.971 333.898 m 445.575 334.601 445.23 333.888 y 445.563 324.881 l 445.69 324.629 445.743 324.906 y 445.971 333.898 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.166 w 2.613 M 446.547 330.13 m 446.32 330.271 446.214 330.394 y 445.637 331.01 445.625 331.483 y 445.609 331.898 445.753 332.135 y 445.871 332.391 446.238 332.526 y 446.456 332.611 446.486 332.589 y 446.775 332.584 446.916 332.351 y 447.385 332.015 446.774 332.025 y 446.485 332.068 446.399 332.132 y 446.039 332.036 446.111 331.503 y 446.183 331.187 446.374 330.842 446.526 330.762 c 446.547 330.13 l b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.166 w 2.613 M 446.773 332.329 m 446.726 332.335 446.676 332.314 446.633 332.335 c 446.614 332.346 446.605 332.37 446.613 332.387 c 446.618 332.4 446.65 332.421 446.671 332.413 c 446.716 332.397 446.727 332.342 446.773 332.329 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.166 w 2.613 M 446.743 325.808 m 446.772 325.974 446.851 326.1 v 446.92 326.209 446.979 326.266 447.094 326.387 c 447.157 326.455 447.247 326.58 447.312 326.659 c 447.534 326.938 447.349 327.239 v 447.264 327.368 447.035 327.568 v 447.04 326.953 l 447.037 326.808 446.646 326.363 y 446.548 326.24 446.499 326.18 446.452 325.829 c 446.415 325.425 446.745 324.995 v 446.725 325.645 l 446.731 325.755 446.743 325.808 v b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.166 w 2.613 M 447.103 329.742 m 447.137 329.638 446.596 329.071 y 446.549 329.017 446.495 328.956 446.433 328.888 c 446.093 328.52 446.11 328.216 v 446.128 327.793 446.542 327.394 v 446.594 327.352 446.663 327.277 v 446.645 327.858 l 446.601 327.912 446.55 327.997 446.507 328.125 c 446.462 328.217 446.586 328.413 v 446.803 328.612 447.508 329.447 v 447.712 329.796 447.551 330.025 v 447.395 330.254 447.12 330.435 v 447.103 329.742 l b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.166 w 2.613 M 446.967 324.712 m 446.988 324.637 446.977 324.545 446.886 324.441 c 446.69 324.159 l 446.91 324.253 447.015 324.384 v 447.146 324.513 447.115 324.752 v 447.092 324.866 446.979 325.049 v 446.967 324.712 l b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 447.28 237.849 m 447.435 237.896 447.553 237.803 447.709 237.896 c 448.021 238.035 448.294 238.127 448.568 238.359 c 448.763 238.498 448.88 238.73 449.075 238.915 c 449.153 238.961 449.28 238.964 449.309 238.822 c 449.349 238.637 449.466 238.591 449.583 238.544 c 450.169 238.313 450.754 238.452 451.34 238.545 c 452.004 238.638 452.472 239.24 453.097 239.518 c 453.409 239.703 453.645 240.059 453.956 240.12 c 454.19 240.166 454.464 240.166 454.659 240.352 c 454.776 240.444 454.737 240.583 v 455.166 240.63 455.479 240.954 455.752 241.325 c 455.83 241.371 455.947 241.463 456.064 241.417 c 456.025 241.417 l 458.914 245.077 l 458.875 245.169 l 458.836 245.308 458.914 245.447 458.836 245.586 c 450.129 243.222 l 450.09 242.898 449.738 242.481 449.543 242.203 c 449.579 242.253 448.884 242.656 448.948 242.785 c 449.364 243.617 449.259 244.385 448.83 245.126 c 448.752 245.311 448.674 245.38 448.556 245.542 c 448.259 245.954 447.775 246.191 447.268 246.098 c 447.151 246.098 l 446.643 246.191 446.292 245.959 445.921 245.635 c 445.752 245.487 445.453 245.172 445.374 244.986 c 444.945 244.246 445.122 243.343 445.454 242.619 c 445.514 242.488 444.812 242.258 444.847 242.208 c 444.652 242.486 444.301 242.903 444.261 243.227 c 435.554 245.588 l 435.476 245.45 435.554 245.311 435.515 245.172 c 435.476 245.079 l 438.365 241.421 l 438.326 241.421 l 438.444 241.467 438.561 241.374 438.639 241.328 c 438.912 240.957 439.224 240.633 439.654 240.587 c 439.615 240.448 439.732 240.355 y 439.927 240.17 440.201 240.17 440.435 240.124 c 440.745 240.062 440.981 239.707 441.294 239.522 c 441.919 239.244 442.387 238.642 443.051 238.549 c 443.637 238.457 444.222 238.318 444.808 238.549 c 444.925 238.596 445.043 238.642 445.081 238.827 c 445.111 238.969 445.238 238.966 445.316 238.92 c 445.511 238.734 445.628 238.503 445.823 238.364 c 446.096 238.133 446.37 238.04 446.682 237.901 c 446.839 237.808 446.955 237.901 447.112 237.855 c 447.28 237.849 l b* Q 438.968 244.466 m 442.843 243.516 l 442.823 243.516 442.823 243.54 442.804 243.54 c 442.901 243.238 443.018 242.936 443.096 242.611 c 443.204 242.159 443.096 241.659 443.076 241.195 c 442.882 241.288 442.862 241.427 v 442.784 241.752 442.784 241.984 442.706 242.309 c 442.687 242.332 442.57 242.449 442.551 242.495 c 442.422 242.801 442.258 242.843 441.986 243.006 c 441.674 243.168 441.363 243.424 441.071 243.563 c 440.448 243.842 439.786 243.888 439.182 244.19 c 439.163 244.213 439.104 244.236 439.085 244.306 c 439.071 244.355 438.91 244.352 438.968 244.466 c f* 439.922 243.679 m 439.961 243.633 440 243.54 440.039 243.516 c 440.214 243.424 440.389 243.447 440.565 243.447 c 440.526 243.47 440.487 243.516 440.448 243.516 c 440.234 243.516 440.097 243.586 439.922 243.679 c f* 440.506 243.076 m 440.681 243.076 440.837 243.099 441.012 243.076 c 441.032 243.052 441.012 243.006 440.993 242.983 c 440.837 242.936 440.681 242.843 440.526 242.797 c 440.487 242.773 440.428 242.797 y 440.35 242.727 440.149 242.696 440.175 242.773 c 440.214 242.89 440.35 242.959 440.448 243.029 c 440.506 243.076 l f* 440.526 242.286 m 440.584 242.286 440.643 242.263 440.701 242.309 c 440.818 242.402 441.012 242.541 441.149 242.565 c 440.526 242.286 l f* 440.993 241.938 m 441.168 241.938 441.382 241.891 441.519 241.961 c 441.577 242.007 441.655 242.1 441.694 242.216 c 441.441 242.17 441.285 242.007 441.032 242.007 c 440.993 241.938 l f* 442.2 241.775 m 442.161 241.775 442.122 241.798 442.083 241.775 c 441.947 241.682 441.791 241.659 441.694 241.52 c 441.655 241.45 441.655 241.357 441.655 241.288 c 441.694 241.288 441.733 241.264 441.752 241.288 c 441.85 241.473 442.025 241.52 442.122 241.682 c 442.2 241.775 l f* 441.85 240.916 m 441.85 240.893 441.85 240.846 441.85 240.823 c 442.083 240.754 442.239 240.962 442.414 241.125 c 442.551 241.241 442.414 241.334 442.297 241.241 c 442.239 241.195 442.142 241.125 442.064 241.055 c 442.005 240.986 441.908 241.032 441.83 240.962 c 441.85 240.939 441.85 240.916 v f* 442.59 240.73 m 442.687 240.73 442.706 240.846 442.784 240.893 c 442.59 240.73 l f* 443.018 240.707 m 443.018 240.661 443.018 240.638 443.018 240.591 c 443.057 240.591 l 443.057 240.545 443.057 240.475 443.057 240.428 c 443.018 240.707 l f* 435.191 245.235 m 435.307 245.258 435.405 245.211 435.502 245.165 c 435.522 245.165 435.561 245.118 435.599 245.095 c 435.716 245.049 435.833 245.002 435.95 244.956 c 436.32 244.84 436.709 244.863 437.06 244.654 c 437.196 244.585 437.352 244.515 437.488 244.468 c 437.858 244.376 438.189 244.376 438.559 244.306 c 438.617 244.283 438.676 244.213 438.754 244.213 c 438.364 244.236 437.975 244.167 437.566 244.236 c 437.352 244.283 437.138 244.259 436.924 244.329 c 436.865 244.352 436.846 244.422 436.787 244.445 c 436.573 244.515 436.378 244.422 436.184 244.492 c 436.106 244.515 436.008 244.515 435.931 244.562 c 435.658 244.654 435.483 244.91 435.268 245.142 c 435.249 245.165 435.288 245.211 435.249 245.235 c 435.191 245.235 l f* 435.639 244.422 m 435.716 244.329 435.775 244.213 435.892 244.167 c 436.086 244.12 436.262 243.981 436.456 243.935 c 436.69 243.865 436.904 243.819 437.138 243.795 c 437.43 243.749 437.702 243.749 437.994 243.656 c 438.014 243.656 438.074 243.641 438.092 243.633 c 438.54 243.424 439.007 243.516 439.455 243.516 c 439.474 243.656 439.416 243.842 439.279 243.865 c 439.065 243.911 438.871 243.795 438.656 243.772 c 438.384 243.726 438.131 243.726 437.858 243.772 c 437.761 243.795 437.683 243.819 437.605 243.865 c 437.352 243.981 437.099 243.865 436.846 243.981 c 436.748 244.027 436.67 244.051 436.573 244.097 c 436.3 244.167 436.028 244.213 435.775 244.329 c 435.639 244.422 l f* 436.573 243.284 m 437.001 243.261 437.449 243.377 437.878 243.238 c 437.956 243.215 438.014 243.099 438.111 243.076 c 438.267 243.052 438.423 243.099 438.578 243.122 c 438.91 243.192 439.241 243.099 439.571 243.168 c 438.987 242.704 438.228 242.866 437.566 242.913 c 437.41 242.913 437.294 243.052 437.157 243.076 c 437.04 243.076 436.904 243.076 436.787 243.122 c 436.729 243.145 436.69 243.192 436.632 243.215 c 436.573 243.284 l f* 437.702 242.216 m 437.683 242.24 437.722 242.263 437.722 242.286 c 438.072 242.263 438.423 242.379 438.773 242.449 c 439.163 242.518 439.552 242.356 439.941 242.518 c 439.883 242.495 439.823 242.468 439.766 242.449 c 439.085 242.216 438.481 242.263 437.819 242.24 c 437.702 242.216 l f* 438.462 241.566 m 438.676 241.52 438.948 241.566 439.163 241.566 c 439.435 241.613 439.722 241.546 440 241.613 c 440.195 241.659 440.175 241.822 440.409 242.077 c 440.117 242.054 439.98 242.03 439.63 242.054 c 439.408 242.069 439.26 241.914 439.046 241.845 c 438.871 241.798 438.871 241.891 438.734 241.775 c 438.462 241.566 l f* 439.202 241.009 m 439.513 240.986 439.805 241.009 440.117 241.079 c 440.136 241.102 440.175 241.125 440.195 241.148 c 440.311 241.195 440.448 241.148 440.565 241.241 c 440.646 241.306 440.701 241.381 440.798 241.427 c 440.818 241.45 440.857 241.682 440.837 241.682 c 440.759 241.705 440.643 241.566 440.565 241.52 c 440.506 241.52 440.487 241.45 440.428 241.427 c 440.175 241.334 440.156 241.473 439.922 241.311 c 439.786 241.218 439.338 241.241 439.221 241.079 c 439.202 241.009 l f* 440.058 240.498 m 440.273 240.475 440.467 240.568 440.662 240.638 c 440.837 240.707 441.032 240.8 441.188 240.962 c 440.857 241.055 440.565 240.777 440.234 240.684 c 440.195 240.684 440.097 240.614 440.117 240.521 c 440.058 240.498 l f* 440.526 240.219 m 440.565 240.08 440.74 240.103 440.818 240.15 c 440.973 240.266 441.207 240.312 441.246 240.545 c 441.168 240.545 441.11 240.568 441.032 240.521 c 440.973 240.475 440.935 240.428 440.896 240.359 c 440.818 240.243 440.662 240.335 440.584 240.196 c 440.526 240.219 l f* 441.227 239.848 m 441.382 239.848 441.538 239.848 441.694 239.848 c 441.674 240.034 441.733 240.219 441.85 240.359 c 441.85 240.382 441.85 240.428 441.85 240.452 c 441.752 240.498 441.674 240.382 441.597 240.312 c 441.538 240.243 441.538 240.127 441.557 240.034 c 441.46 240.034 441.363 239.987 441.304 239.895 c 441.227 239.848 l f* 442.025 239.732 m 442.2 239.778 442.297 239.964 442.453 240.034 c 442.025 239.732 l f* 442.473 239.755 m 442.59 239.755 442.648 239.941 442.745 240.034 c 442.473 239.755 l f* 442.921 239.732 m 443.062 239.732 443.213 239.662 443.349 239.732 c 443.349 239.802 l 443.252 239.848 443.213 240.034 443.096 239.987 c 443.076 239.987 443.057 239.871 443.018 239.825 c 442.998 239.825 442.979 239.825 442.959 239.825 c 442.921 239.802 442.901 239.732 442.921 239.732 c f* 452.997 244.462 m 449.122 243.512 l 449.142 243.512 449.142 243.535 449.161 243.535 c 449.064 243.233 448.947 242.931 448.87 242.606 c 448.761 242.155 448.87 241.654 448.889 241.19 c 449.084 241.283 449.103 241.422 v 449.181 241.747 449.181 241.98 449.259 242.304 c 449.278 242.328 449.395 242.444 449.415 242.49 c 449.543 242.797 449.707 242.839 449.979 243.001 c 450.291 243.164 450.602 243.419 450.894 243.559 c 451.517 243.837 452.179 243.884 452.783 244.186 c 452.802 244.209 452.861 244.232 452.88 244.302 c 452.894 244.351 453.055 244.349 452.997 244.462 c f* 452.043 243.675 m 452.004 243.629 451.965 243.536 451.926 243.513 c 451.751 243.42 451.576 243.443 451.401 243.443 c 451.44 243.466 451.479 243.513 451.517 243.513 c 451.732 243.513 451.868 243.582 452.043 243.675 c f* 451.459 243.071 m 451.284 243.071 451.128 243.094 450.953 243.071 c 450.933 243.048 450.953 243.002 450.972 242.978 c 451.128 242.932 451.284 242.839 451.44 242.793 c 451.479 242.77 451.537 242.793 y 451.615 242.723 451.816 242.692 451.79 242.77 c 451.751 242.886 451.615 242.955 451.517 243.025 c 451.459 243.071 l f* 451.44 242.282 m 451.381 242.282 451.323 242.259 451.265 242.305 c 451.148 242.398 450.953 242.537 450.817 242.56 c 451.44 242.282 l f* 450.973 241.934 m 450.797 241.934 450.583 241.887 450.447 241.956 c 450.388 242.003 450.31 242.096 450.271 242.212 c 450.525 242.166 450.681 242.003 450.934 242.003 c 450.973 241.934 l f* 449.765 241.771 m 449.804 241.771 449.843 241.794 449.882 241.771 c 450.019 241.678 450.174 241.655 450.271 241.516 c 450.311 241.446 450.311 241.353 450.311 241.283 c 450.272 241.283 450.233 241.26 450.213 241.283 c 450.116 241.469 449.941 241.515 449.843 241.678 c 449.765 241.771 l f* 450.116 240.912 m 450.116 240.889 450.116 240.842 450.116 240.819 c 449.883 240.749 449.727 240.958 449.551 241.121 c 449.415 241.237 449.551 241.329 449.668 241.237 c 449.727 241.19 449.824 241.121 449.902 241.051 c 449.96 240.981 450.058 241.028 450.135 240.958 c 450.116 240.935 450.116 240.912 v f* 449.376 240.726 m 449.279 240.726 449.259 240.842 449.181 240.888 c 449.376 240.726 l f* 448.948 240.702 m 448.948 240.656 448.948 240.633 448.948 240.586 c 448.909 240.586 l 448.909 240.54 448.909 240.47 448.909 240.424 c 448.948 240.702 l f* 456.774 245.232 m 456.657 245.255 456.56 245.209 456.463 245.162 c 456.443 245.162 456.404 245.116 456.365 245.092 c 456.249 245.046 456.132 245 456.015 244.953 c 455.645 244.837 455.255 244.86 454.905 244.651 c 454.769 244.581 454.613 244.512 454.477 244.465 c 454.107 244.372 453.776 244.372 453.406 244.302 c 453.347 244.279 453.289 244.209 453.211 244.209 c 453.601 244.233 453.99 244.163 454.399 244.233 c 454.613 244.279 454.827 244.256 455.042 244.326 c 455.1 244.349 455.119 244.419 455.178 244.442 c 455.392 244.512 455.586 244.419 455.781 244.489 c 455.859 244.512 455.957 244.512 456.034 244.558 c 456.307 244.651 456.482 244.907 456.696 245.139 c 456.716 245.162 456.677 245.209 456.716 245.232 c 456.774 245.232 l f* 456.326 244.419 m 456.249 244.326 456.19 244.21 456.073 244.164 c 455.879 244.117 455.703 243.978 455.509 243.931 c 455.275 243.862 455.061 243.815 454.827 243.792 c 454.535 243.745 454.263 243.745 453.971 243.652 c 453.951 243.652 453.891 243.638 453.873 243.629 c 453.426 243.42 452.958 243.513 452.51 243.513 c 452.491 243.652 452.549 243.838 452.686 243.861 c 452.9 243.908 453.095 243.791 453.309 243.768 c 453.581 243.722 453.835 243.722 454.107 243.768 c 454.204 243.792 454.282 243.815 454.36 243.862 c 454.613 243.978 454.866 243.862 455.119 243.978 c 455.217 244.024 455.295 244.047 455.392 244.094 c 455.665 244.164 455.937 244.21 456.19 244.326 c 456.326 244.419 l f* 455.392 243.281 m 454.964 243.258 454.516 243.374 454.088 243.235 c 454.01 243.211 453.951 243.095 453.854 243.072 c 453.698 243.049 453.543 243.095 453.387 243.118 c 453.056 243.188 452.725 243.095 452.394 243.165 c 452.978 242.7 453.737 242.863 454.399 242.91 c 454.555 242.91 454.672 243.049 454.808 243.072 c 454.925 243.072 455.061 243.072 455.178 243.119 c 455.236 243.142 455.275 243.188 455.334 243.211 c 455.392 243.281 l f* 454.263 242.213 m 454.282 242.236 454.244 242.26 454.244 242.283 c 453.893 242.259 453.543 242.375 453.192 242.445 c 452.803 242.514 452.413 242.352 452.024 242.514 c 452.082 242.491 452.143 242.464 452.199 242.445 c 452.881 242.213 453.484 242.259 454.146 242.236 c 454.263 242.213 l f* 453.504 241.562 m 453.29 241.516 453.017 241.562 452.803 241.562 c 452.53 241.609 452.243 241.543 451.966 241.609 c 451.771 241.655 451.79 241.818 451.557 242.073 c 451.849 242.05 451.985 242.026 452.335 242.05 c 452.557 242.065 452.705 241.911 452.92 241.841 c 453.095 241.795 453.095 241.887 453.231 241.771 c 453.504 241.562 l f* 452.764 241.005 m 452.453 240.982 452.16 241.005 451.849 241.075 c 451.829 241.098 451.79 241.121 451.771 241.144 c 451.654 241.191 451.518 241.144 451.401 241.237 c 451.32 241.301 451.265 241.376 451.167 241.423 c 451.148 241.446 451.109 241.678 451.128 241.678 c 451.206 241.701 451.323 241.562 451.401 241.516 c 451.459 241.516 451.479 241.446 451.537 241.423 c 451.79 241.33 451.81 241.469 452.043 241.307 c 452.18 241.214 452.628 241.238 452.745 241.075 c 452.764 241.005 l f* 451.907 240.494 m 451.693 240.471 451.499 240.564 451.304 240.633 c 451.128 240.703 450.934 240.796 450.778 240.958 c 451.109 241.051 451.401 240.772 451.732 240.68 c 451.771 240.68 451.868 240.61 451.849 240.517 c 451.907 240.494 l f* 451.44 240.216 m 451.401 240.076 451.226 240.099 451.148 240.145 c 450.992 240.262 450.759 240.308 450.72 240.54 c 450.798 240.54 450.856 240.564 450.934 240.517 c 450.992 240.471 451.031 240.424 451.07 240.355 c 451.148 240.239 451.304 240.332 451.382 240.192 c 451.44 240.216 l f* 450.739 239.844 m 450.583 239.844 450.428 239.844 450.272 239.844 c 450.291 240.029 450.233 240.215 450.116 240.354 c 450.116 240.378 450.116 240.424 450.116 240.447 c 450.213 240.494 450.291 240.378 450.369 240.308 c 450.428 240.238 450.428 240.122 450.408 240.029 c 450.506 240.029 450.603 239.983 450.661 239.89 c 450.739 239.844 l f* 449.941 239.727 m 449.766 239.774 449.668 239.96 449.513 240.029 c 449.941 239.727 l f* 449.493 239.751 m 449.376 239.751 449.318 239.936 449.221 240.029 c 449.493 239.751 l f* 449.045 239.727 m 448.904 239.727 448.753 239.658 448.617 239.727 c 448.617 239.797 l 448.714 239.843 448.753 240.029 448.87 239.983 c 448.889 239.983 448.909 239.867 448.948 239.82 c 448.968 239.82 448.987 239.82 449.006 239.82 c 449.045 239.797 449.065 239.727 449.045 239.727 c f* 445.404 243.152 m 445.579 243.094 445.768 243.063 445.963 243.063 c 446.921 243.063 447.698 243.813 447.698 244.738 c 447.698 245.662 446.921 246.412 445.963 246.412 c 445.005 246.412 444.229 245.662 444.229 244.738 c 444.229 244.002 444.72 243.377 445.404 243.152 c f* q 0.9973 0 0 1.0027 0 0 cm 1 J 1 j 0.333 w 2.613 M 446.615 242.493 m 446.791 242.435 446.98 242.404 447.176 242.404 c 448.137 242.404 448.915 243.152 448.915 244.074 c 448.915 244.996 448.137 245.744 447.176 245.744 c 446.215 245.744 445.437 244.996 445.437 244.074 c 445.437 243.34 445.929 242.717 446.615 242.493 c S Q q 0.9973 0 0 1.0027 0 0 cm 1 J 1 j 0.166 w 2.613 M 448.532 244.75 m 446.336 242.805 l 446.292 242.788 l 447.171 245.636 l 447.185 245.584 l 448.02 242.735 l 445.887 244.709 l 445.867 244.75 l 448.532 244.75 l S Q 445.47 244.842 m 445.48 244.819 445.518 244.729 445.531 244.709 c 445.57 244.651 445.583 244.653 445.574 244.571 c 445.567 244.513 445.573 244.51 445.615 244.467 c 445.674 244.408 445.671 244.275 445.74 244.217 c 445.769 244.194 445.915 244.373 445.926 244.384 c 446.003 244.456 446.051 244.342 446.206 244.225 c 446.293 244.161 446.3 244.488 446.279 244.634 c 446.275 244.659 446.445 244.819 446.445 244.842 c 446.474 245.086 446.467 245 446.32 245.197 c 446.301 245.209 446.136 245.324 446.127 245.348 c 445.99 245.534 445.988 245.461 445.823 245.426 c 445.813 245.426 445.796 245.365 445.802 245.343 c 445.832 245.235 445.633 245.283 445.594 245.26 c 445.526 245.202 445.496 245.189 445.447 245.108 c 445.418 245.038 445.418 244.957 445.408 244.887 c 445.47 244.842 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 1 J 1 j 0.166 w 2.613 M 446.681 244.179 m 446.691 244.155 446.729 244.065 446.743 244.045 c 446.782 243.987 446.795 243.989 446.785 243.908 c 446.778 243.85 446.784 243.847 446.827 243.804 c 446.885 243.746 446.883 243.612 446.952 243.555 c 446.981 243.531 447.128 243.711 447.139 243.721 c 447.216 243.793 447.264 243.679 447.42 243.563 c 447.506 243.499 447.513 243.825 447.492 243.971 c 447.489 243.996 447.659 244.155 447.659 244.179 c 447.688 244.422 447.681 244.336 447.534 244.532 c 447.514 244.544 447.349 244.659 447.34 244.683 c 447.203 244.868 447.201 244.796 447.035 244.761 c 447.025 244.761 447.008 244.7 447.014 244.678 c 447.044 244.57 446.845 244.618 446.806 244.595 c 446.738 244.537 446.707 244.524 446.658 244.443 c 446.629 244.374 446.629 244.293 446.619 244.223 c S Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 0 0 0 0 K 0.333 w 2.613 M 447.286 241.486 m 447.42 241.486 l 447.454 241.45 447.518 241.462 447.571 241.516 c 447.624 241.57 447.675 241.639 447.685 241.674 c 447.803 241.797 447.994 241.745 448.211 241.59 c 448.274 241.508 448.621 241.23 449.053 241.04 c 449.116 240.964 448.846 241.042 448.794 241.061 c 448.878 241.007 448.785 240.961 448.594 241.051 c 448.646 240.963 448.535 240.986 448.405 241.055 c 448.479 240.966 448.355 240.978 448.249 241.047 c 448.294 240.964 448.177 240.968 448.087 241.054 c 448.132 240.975 448.023 240.975 447.943 241.05 c 447.991 240.967 447.838 240.992 447.785 241.055 c 447.827 240.99 447.641 241.026 447.625 241.092 c 447.599 241.003 447.445 240.986 447.408 241.055 c 447.296 241.055 l 447.203 240.962 447.06 241.016 447.045 241.21 c 446.903 240.985 446.699 240.942 446.763 241.063 c 446.651 240.958 446.591 240.994 446.606 241.055 c 446.442 240.913 446.434 241.034 446.45 241.057 c 446.341 240.969 446.248 240.986 446.278 241.045 c 446.176 240.991 446.054 240.981 446.108 241.058 c 445.988 240.987 445.821 240.989 445.893 241.062 c 445.725 240.994 445.542 241.008 445.699 241.073 c 446.172 241.268 446.324 241.454 446.499 241.593 c 446.775 241.813 446.987 241.761 447.035 241.644 c 447.08 241.536 447.228 241.423 447.282 241.479 c 447.286 241.486 l b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 0 0 0 0 K 0.333 w 2.613 M 447.287 238.619 m 447.287 238.588 447.3 238.566 447.343 238.566 c 447.386 238.566 447.399 238.593 447.399 238.621 c 447.424 241.571 l 447.28 241.571 l 447.287 238.619 l b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 0 0 0 0 K 0.333 w 2.613 M 447.344 241.516 m 447.344 241.533 447.403 241.538 447.403 241.519 c 447.382 238.671 l 447.382 238.651 447.371 238.608 447.356 238.608 c 447.345 238.608 447.344 238.648 447.344 238.671 c 447.344 241.516 l b* Q 0 0 0 1 k 446.461 241.97 m 446.426 241.994 446.381 241.987 y 446.437 241.963 446.456 241.941 446.43 241.808 c 446.461 241.97 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.675 241.314 m 447.64 241.338 447.594 241.331 y 447.651 241.306 447.67 241.285 447.644 241.153 c S Q 447.245 242.033 m 447.268 242.015 447.134 242.005 y 447.161 241.983 447.002 241.987 y 447.027 241.958 446.905 241.948 y 446.92 241.925 446.79 241.91 y 446.805 241.889 446.699 241.888 y 446.71 241.866 446.591 241.877 y 446.6 241.849 446.442 241.885 y 447.245 242.033 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.461 241.376 m 448.484 241.359 448.349 241.348 y 448.377 241.327 448.217 241.331 y 448.243 241.302 448.12 241.292 y 448.136 241.269 448.005 241.254 y 448.02 241.233 447.914 241.232 y 447.924 241.21 447.805 241.221 y 447.814 241.193 447.656 241.229 y S Q 447.061 242.189 m 447.06 242.142 446.916 242.181 y 446.913 242.141 446.778 242.166 y 446.787 242.13 446.651 242.135 y 446.661 242.1 446.573 242.11 y 446.6 242.055 446.511 242.031 y 446.532 241.975 446.427 241.984 y 447.061 242.189 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.277 241.532 m 448.275 241.485 448.131 241.524 y 448.128 241.484 447.993 241.51 y 448.002 241.474 447.866 241.478 y 447.875 241.444 447.787 241.453 y 447.814 241.399 447.725 241.375 y 447.746 241.319 447.641 241.328 y S Q 445.818 241.971 m 445.853 241.995 445.898 241.988 y 445.842 241.964 445.823 241.942 445.848 241.81 c 445.818 241.971 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.03 241.315 m 447.065 241.339 447.111 241.332 y 447.054 241.307 447.035 241.286 447.06 241.154 c S Q 445.034 242.037 m 445.011 242.02 445.146 242.009 y 445.118 241.987 445.277 241.99 y 445.252 241.961 445.374 241.951 y 445.358 241.928 445.488 241.912 y 445.474 241.892 445.58 241.891 y 445.569 241.868 445.687 241.879 y 445.679 241.851 445.837 241.886 y 445.034 242.037 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.244 241.38 m 446.221 241.363 446.356 241.352 y 446.329 241.331 446.488 241.334 y 446.462 241.305 446.585 241.295 y 446.569 241.272 446.7 241.256 y 446.685 241.236 446.791 241.235 y 446.78 241.212 446.899 241.223 y 446.89 241.195 447.049 241.23 y S Q 445.219 242.193 m 445.22 242.145 445.364 242.184 y 445.368 242.144 445.502 242.169 y 445.493 242.133 445.629 242.137 y 445.619 242.102 445.707 242.111 y 445.679 242.057 445.768 242.032 y 445.747 241.977 445.852 241.985 y 445.219 242.193 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.43 241.536 m 446.431 241.488 446.575 241.527 y 446.578 241.487 446.713 241.512 y 446.705 241.476 446.84 241.48 y 446.831 241.446 446.919 241.455 y 446.891 241.4 446.98 241.376 y 446.959 241.321 447.064 241.329 y S Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.351 241.558 m 447.253 241.559 447.174 241.621 447.174 241.698 c 447.175 241.775 447.254 241.837 447.352 241.837 c 447.45 241.837 447.529 241.774 447.529 241.697 c 447.528 241.62 447.449 241.558 447.351 241.558 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.335 241.766 m 447.358 241.77 447.344 241.794 447.322 241.794 c 447.26 241.791 447.221 241.743 447.221 241.696 c 447.221 241.672 447.228 241.644 447.243 241.626 c 447.252 241.616 447.274 241.594 447.262 241.599 c 447.218 241.617 447.197 241.658 447.197 241.699 c 447.198 241.766 447.267 241.821 447.353 241.821 c 447.439 241.821 447.508 241.766 447.508 241.698 c 447.508 241.634 447.445 241.58 447.36 241.575 c 447.346 241.574 447.325 241.575 447.318 241.582 c 447.317 241.584 447.346 241.582 447.36 241.584 c 447.425 241.592 447.469 241.634 447.465 241.686 c 447.464 241.699 447.438 241.724 447.441 241.703 c 447.446 241.668 447.403 241.642 447.359 241.641 c 447.324 241.64 447.28 241.669 447.28 241.704 c 447.28 241.738 447.291 241.759 447.335 241.766 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.917 240.734 m 446.89 240.396 447.918 240.735 447.892 240.308 c 447.866 239.9 447.093 240.182 447.118 239.959 c 447.131 239.844 447.797 239.921 447.741 239.654 c 447.689 239.405 447.142 239.528 447.163 239.418 c 447.186 239.295 447.721 239.355 447.621 239.133 c 447.539 238.953 447.124 239.077 447.119 238.88 c 446.967 239.058 447.459 239.042 447.489 239.16 c 447.515 239.26 447.048 239.214 447.002 239.408 c 446.944 239.651 447.521 239.541 447.546 239.677 c 447.568 239.794 446.96 239.695 446.897 239.899 c 446.766 240.323 447.568 240.081 447.62 240.308 c 447.667 240.514 446.805 240.27 446.728 240.67 c 446.698 240.823 446.824 240.867 446.9 240.897 c 446.931 240.909 446.924 240.939 446.994 240.95 c 447.056 240.961 447.106 240.943 447.231 240.82 c 447.248 240.803 447.201 240.773 447.163 240.766 c 447.125 240.76 447.029 240.747 446.989 240.777 c 446.953 240.804 446.92 240.772 446.917 240.734 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.783 240.732 m 447.807 240.395 446.781 240.737 446.805 240.31 c 446.828 239.902 447.603 240.181 447.577 239.958 c 447.563 239.843 446.897 239.922 446.952 239.655 c 447.002 239.406 447.55 239.527 447.528 239.417 c 447.504 239.295 446.97 239.356 447.069 239.134 c 447.149 238.953 447.565 239.076 447.569 238.879 c 447.722 239.056 447.23 239.042 447.201 239.161 c 447.176 239.261 447.642 239.213 447.69 239.407 c 447.749 239.649 447.171 239.541 447.147 239.678 c 447.126 239.795 447.733 239.694 447.797 239.897 c 447.931 240.321 447.127 240.082 447.077 240.309 c 447.031 240.516 447.892 240.267 447.971 240.668 c 448.002 240.82 447.877 240.865 447.8 240.896 c 447.77 240.908 447.777 240.937 447.707 240.949 c 447.645 240.959 447.594 240.942 447.469 240.819 c 447.452 240.803 447.499 240.773 447.537 240.766 c 447.575 240.759 447.67 240.746 447.711 240.775 c 447.747 240.802 447.78 240.771 447.783 240.732 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.619 240.04 m 447.658 240.047 447.76 240.021 447.747 239.954 c 447.703 239.733 447.116 239.838 447.109 239.695 c 447.104 239.61 447.252 239.602 447.185 239.59 c 447.104 239.575 446.989 239.628 446.991 239.693 c 446.998 239.889 447.575 239.835 447.615 239.948 c 447.636 240.008 447.579 240.031 447.619 240.04 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.665 240.381 m 447.71 240.39 447.814 240.357 447.802 240.278 c 447.76 239.992 447.063 240.166 447.046 239.987 c 447.037 239.887 447.215 239.877 447.136 239.863 c 447.041 239.845 446.918 239.914 446.926 239.989 c 446.953 240.249 447.619 240.105 447.66 240.272 c 447.677 240.345 447.617 240.371 447.665 240.381 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.582 239.724 m 447.615 239.731 447.688 239.711 447.677 239.655 c 447.641 239.466 447.159 239.555 447.135 239.434 c 447.121 239.359 447.247 239.355 447.19 239.344 c 447.122 239.331 447.032 239.382 447.034 239.432 c 447.041 239.599 447.537 239.555 447.571 239.651 c 447.59 239.702 447.548 239.717 447.582 239.724 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.558 239.462 m 447.585 239.468 447.645 239.452 447.639 239.403 c 447.621 239.27 447.218 239.284 447.174 239.174 c 447.15 239.112 447.27 239.106 447.222 239.097 c 447.163 239.086 447.094 239.129 447.089 239.172 c 447.07 239.321 447.524 239.297 447.549 239.4 c 447.559 239.444 447.529 239.456 447.558 239.462 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.145 238.972 m 447.173 239.062 447.504 239.046 447.513 239.163 c 447.516 239.201 447.496 239.211 447.521 239.216 c 447.544 239.221 447.591 239.207 447.589 239.166 c 447.584 239.038 447.209 239.03 447.145 238.972 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.726 240.899 m 447.881 240.852 447.91 240.755 447.897 240.685 c 447.835 240.349 447.014 240.545 446.993 240.334 c 446.982 240.216 447.192 240.204 447.099 240.188 c 446.987 240.167 446.847 240.245 446.854 240.336 c 446.878 240.664 447.691 240.425 447.804 240.665 c 447.828 240.718 447.823 240.857 447.698 240.852 c 447.605 240.849 447.56 240.859 447.613 240.899 c 447.653 240.929 447.709 240.921 447.726 240.899 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.802 240.687 m 446.852 240.532 447.057 240.566 447.027 240.577 c 446.957 240.6 446.913 240.625 446.883 240.674 c 446.815 240.784 446.868 240.882 446.995 240.859 c 447.087 240.842 447.14 240.86 447.087 240.9 c 447.048 240.93 446.992 240.923 446.975 240.901 c 446.82 240.854 446.773 240.777 446.802 240.687 c b* Q 446.43 241.808 m 446.415 241.732 446.373 241.668 446.286 241.667 c 446.219 241.667 446.204 241.704 y 446.43 241.808 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.644 241.153 m 447.629 241.076 447.586 241.012 447.499 241.012 c 447.433 241.012 447.417 241.048 y S Q 446.877 241.709 m 446.906 241.691 446.861 241.629 446.804 241.662 c 446.625 241.768 446.591 241.877 y 446.495 241.933 446.461 241.97 y 446.877 241.709 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.092 241.054 m 448.122 241.035 448.076 240.973 448.019 241.007 c 447.839 241.112 447.805 241.221 y 447.709 241.277 447.675 241.314 y S Q 446.724 241.716 m 446.768 241.689 446.725 241.626 446.644 241.669 c 446.523 241.733 446.442 241.885 y 446.724 241.716 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.939 241.06 m 447.982 241.033 447.94 240.971 447.858 241.014 c 447.737 241.078 447.656 241.229 y S Q 446.207 242.147 m 446.279 242.069 446.419 242.219 446.461 242.311 c 446.503 242.4 446.678 242.494 447.003 242.239 c 447.15 242.124 447.26 241.961 447.814 241.712 c 447.882 241.682 447.842 241.658 447.749 241.674 c 447.416 241.73 447.134 242.005 y 447.002 242.069 446.916 242.181 y 446.844 242.251 446.781 242.28 y 446.207 242.147 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.42 241.49 m 447.492 241.412 447.632 241.562 447.675 241.654 c 447.717 241.743 447.892 241.837 448.218 241.582 c 448.366 241.467 448.476 241.305 449.032 241.057 c 449.1 241.026 449.06 241.003 448.966 241.019 c 448.633 241.074 448.349 241.348 y 448.218 241.412 448.131 241.524 y 448.059 241.594 447.995 241.623 y S Q 447.577 241.721 m 447.641 241.688 447.603 241.642 447.507 241.664 c 447.245 241.725 447.002 241.987 y 446.892 242.051 446.778 242.166 y 446.664 242.254 446.616 242.26 y 447.577 241.721 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.794 241.066 m 448.858 241.032 448.82 240.987 448.724 241.009 c 448.461 241.07 448.217 241.331 y 448.107 241.394 447.993 241.51 y 447.879 241.597 447.83 241.603 y S Q 447.37 241.711 m 447.424 241.678 447.384 241.636 447.304 241.663 c 447.073 241.74 446.905 241.948 y 446.746 242.041 446.651 242.135 y 446.607 242.198 446.531 242.217 y 447.37 241.711 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.586 241.056 m 448.641 241.022 448.6 240.981 448.52 241.008 c 448.289 241.085 448.12 241.292 y 447.961 241.385 447.866 241.478 y 447.821 241.542 447.745 241.56 y S Q 447.194 241.71 m 447.24 241.681 447.204 241.63 447.139 241.657 c 446.955 241.731 446.79 241.91 y 446.642 241.996 446.573 242.11 y 446.55 242.148 446.488 242.168 y 447.194 241.71 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.41 241.055 m 448.456 241.026 448.42 240.975 448.355 241.001 c 448.17 241.075 448.005 241.254 y 447.857 241.34 447.787 241.453 y 447.764 241.491 447.702 241.512 y S Q 447.033 241.707 m 447.071 241.685 447.027 241.624 446.969 241.652 c 446.836 241.716 446.699 241.888 y 446.579 241.955 446.511 242.031 y 446.475 242.073 446.41 242.075 y 447.033 241.707 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 448.249 241.052 m 448.286 241.029 448.242 240.969 448.185 240.996 c 448.051 241.06 447.914 241.232 y 447.793 241.299 447.725 241.375 y 447.689 241.417 447.624 241.418 y S Q 445.401 241.712 m 445.371 241.693 445.416 241.632 445.473 241.665 c 445.653 241.77 445.687 241.879 y 445.783 241.934 445.818 241.971 y 445.401 241.712 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.612 241.056 m 446.582 241.038 446.627 240.976 446.684 241.009 c 446.865 241.114 446.899 241.223 y 446.995 241.278 447.03 241.315 y S Q 445.848 241.81 m 445.862 241.733 445.905 241.67 445.991 241.672 c 446.063 241.674 446.083 241.716 y 445.848 241.81 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.06 241.154 m 447.075 241.077 447.117 241.015 447.204 241.017 c 447.276 241.018 447.295 241.06 y S Q 445.554 241.718 m 445.509 241.691 445.552 241.628 445.634 241.671 c 445.755 241.734 445.837 241.886 y 445.554 241.718 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.765 241.063 m 446.721 241.036 446.763 240.973 446.845 241.016 c 446.967 241.079 447.049 241.23 y S Q 446.073 242.147 m 446.001 242.069 445.862 242.22 445.82 242.312 c 445.779 242.402 445.604 242.496 445.278 242.243 c 445.13 242.128 445.019 241.965 444.463 241.719 c 444.396 241.689 444.435 241.665 444.529 241.68 c 444.861 241.734 445.146 242.009 y 445.277 242.072 445.364 242.184 y 445.437 242.254 445.5 242.282 y 446.073 242.147 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.286 241.491 m 447.214 241.412 447.074 241.563 447.032 241.655 c 446.991 241.744 446.816 241.839 446.488 241.586 c 446.34 241.471 446.229 241.309 445.672 241.063 c 445.604 241.033 445.644 241.009 445.738 241.025 c 446.071 241.079 446.356 241.352 y 446.488 241.415 446.575 241.527 y 446.648 241.597 446.711 241.625 y S Q 444.701 241.726 m 444.637 241.693 444.674 241.648 444.77 241.669 c 445.033 241.729 445.277 241.99 y 445.388 242.053 445.502 242.169 y 445.616 242.255 445.665 242.262 y 444.701 241.726 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 445.91 241.071 m 445.846 241.038 445.883 240.993 445.979 241.014 c 446.243 241.074 446.488 241.334 y 446.599 241.397 446.713 241.512 y 446.828 241.598 446.877 241.605 y S Q 444.908 241.716 m 444.854 241.683 444.894 241.641 444.973 241.667 c 445.204 241.744 445.374 241.951 y 445.533 242.043 445.629 242.137 y 445.674 242.2 445.75 242.218 y 444.908 241.716 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.118 241.06 m 446.063 241.027 446.103 240.986 446.183 241.012 c 446.415 241.088 446.585 241.295 y 446.745 241.387 446.84 241.48 y 446.885 241.543 446.962 241.562 y S Q 445.084 241.714 m 445.037 241.686 445.073 241.634 445.138 241.661 c 445.323 241.734 445.488 241.912 y 445.637 241.997 445.707 242.111 y 445.731 242.15 445.792 242.17 y 445.084 241.714 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.294 241.059 m 446.247 241.03 446.283 240.979 446.349 241.005 c 446.534 241.078 446.7 241.256 y 446.849 241.341 446.919 241.455 y 446.943 241.493 447.004 241.513 y S Q 445.244 241.71 m 445.207 241.688 445.25 241.628 445.308 241.655 c 445.441 241.719 445.58 241.891 y 445.7 241.957 445.768 242.032 y 445.809 242.074 445.87 242.076 y 445.244 241.71 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 446.455 241.055 m 446.417 241.033 446.461 240.972 446.519 241 c 446.653 241.063 446.791 241.235 y 446.912 241.301 446.98 241.376 y 447.021 241.418 447.082 241.419 y S Q 446.565 241.723 m 446.603 241.693 446.555 241.666 446.485 241.69 c 446.417 241.713 446.416 241.763 y 446.565 241.723 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.78 241.068 m 447.818 241.037 447.769 241.011 447.699 241.034 c 447.63 241.057 447.63 241.107 y S Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.333 w 2.613 M 447.499 239.011 m 447.485 239.018 447.443 239.009 447.456 239.005 c 447.499 238.991 447.528 238.986 447.544 238.971 c 447.538 238.991 447.526 238.999 447.499 239.011 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 0 K 0.176 w 2.613 M 447.312 242.314 m 446.258 242.314 445.214 242.19 444.983 241.149 c 444.761 240.15 444.816 240.483 445.204 239.318 c S Q 490.413 290.079 m 490.675 290.24 491.477 291.459 491.509 291.409 c 491.989 290.643 492.645 289.87 494.048 289.87 c 495.449 289.87 496.586 290.559 496.586 291.409 c 496.586 290.559 497.68 289.911 499.081 289.911 c 500.484 289.911 501.183 290.563 501.62 291.449 c 501.637 291.527 l 501.896 291.36 503.149 290.527 503.11 290.482 c 499.169 287.661 507.313 281.778 497.776 278.381 c 497.289 278.243 497.068 277.909 v 496.98 278.071 496.279 278.393 y 485.991 280.65 494.659 287.258 490.413 290.079 c f* q 0.9973 0 0 1.0027 0 0 cm 1 J 1 j 0.333 w 2.613 M 491.746 289.293 m 492.009 289.453 492.814 290.669 492.845 290.619 c 493.326 289.855 493.985 289.084 495.391 289.084 c 496.796 289.084 497.936 289.771 497.936 290.619 c 497.936 290.619 l 497.936 289.771 499.033 289.125 500.438 289.125 c 501.844 289.125 502.546 289.775 502.984 290.659 c 503.001 290.736 l 503.26 290.57 504.517 289.74 504.478 289.695 c 504.478 289.695 l 500.526 286.881 508.692 281.014 499.13 277.626 c 498.641 277.489 498.419 277.156 v 498.419 277.156 l 498.331 277.317 497.629 277.638 y 487.312 279.889 496.004 286.48 491.746 289.293 c S Q 0 0 0 0 k 494.105 280.52 m 495.027 284.268 l 492.69 286.347 l 495.621 286.351 l 496.548 289.802 l 497.62 286.337 l 500.781 286.344 l 498.235 284.102 l 499.341 280.52 l 496.769 282.822 l 494.105 280.52 l f* q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 389.54 286.714 m 389.21 286.645 389.034 286.624 388.829 286.209 c 388.754 286.058 388.676 285.888 388.575 285.75 c 388.168 285.153 388.244 284.442 388.295 283.8 c 388.346 283.708 388.397 283.581 388.397 283.478 c 388.397 283.341 388.539 283.252 388.575 283.111 c 388.651 282.813 388.905 282.698 389.057 282.468 c 389.159 282.377 389.515 282.124 389.515 282.17 c 389.515 282.767 389.337 283.399 389.21 283.891 c 389.032 284.58 389.261 285.245 389.413 285.979 c 389.515 286.255 389.489 286.438 389.54 286.714 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 392.412 279.784 m 392.503 279.489 392.518 279.228 392.987 279.062 c 393.157 279.002 393.349 278.939 393.506 278.854 c 394.185 278.515 394.968 278.617 395.677 278.693 c 395.776 278.743 395.914 278.795 396.027 278.8 c 396.18 278.806 396.27 278.938 396.425 278.977 c 396.751 279.06 396.867 279.294 397.113 279.443 c 397.21 279.538 397.473 279.871 397.422 279.869 c 396.762 279.841 396.07 279.651 395.533 279.514 c 394.779 279.321 394.033 279.496 393.213 279.6 c 392.904 279.679 392.719 279.751 392.412 279.784 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 400.187 282.4 m 400.512 282.488 400.685 282.518 400.861 282.944 c 400.925 283.099 400.991 283.274 401.082 283.417 c 401.446 284.036 401.427 284.756 401.33 285.394 c 401.273 285.483 401.223 285.636 401.216 285.738 c 401.191 286.092 400.914 286.36 400.949 286.255 c 400.852 286.548 400.698 286.482 400.53 286.702 c 400.422 286.788 400.184 286.954 400.187 286.909 c 400.229 286.313 400.292 285.774 400.454 285.291 c 400.68 284.614 400.362 283.881 400.262 283.14 c 400.18 282.859 400.218 282.677 400.187 282.4 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 397.448 289.156 m 397.372 289.455 397.349 289.613 396.89 289.799 c 396.723 289.867 396.534 289.938 396.382 290.029 c 395.722 290.397 394.934 290.329 394.223 290.284 c 394.121 290.238 393.98 290.192 393.867 290.193 c 393.714 290.193 393.617 290.065 393.46 290.032 c 393.13 289.964 393.002 289.735 392.748 289.597 c 392.646 289.505 392.366 289.184 392.417 289.184 c 393.078 289.184 393.779 289.344 394.323 289.458 c 395.086 289.618 395.822 289.41 396.635 289.272 c 396.94 289.18 397.143 289.203 397.448 289.156 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 1 j 1.331 w 2.613 M 394.775 280.103 m 397.543 280.103 399.788 282.14 399.788 284.654 c 399.788 287.168 397.543 289.206 394.775 289.206 c 392.006 289.206 389.762 287.168 389.762 284.654 c 389.762 282.14 392.006 280.103 394.775 280.103 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 390.695 287.312 m 388.103 289.308 l 387.874 289.102 388.133 288.837 387.705 287.979 c 387.543 287.654 387.531 286.864 387.379 286.486 c 387.379 286.417 387.417 286.555 387.379 286.486 c 387.341 286.314 386.997 285.556 387.036 285.384 c 386.997 285.384 387.036 285.384 y 386.921 284.902 386.921 284.455 386.959 283.973 c 386.977 283.612 387.058 283.533 387.35 282.319 c 387.426 282.009 387.718 281.204 387.794 280.86 c 387.87 280.55 388.027 279.912 388.141 279.636 c 388.179 279.567 387.989 279.602 388.141 279.636 c 390.923 281.667 l 390.86 281.788 391.012 281.534 390.923 281.667 c 390.701 282.153 390.238 282.894 390.149 283.425 c 390.016 284 390.016 284.619 390.06 285.193 c 390.06 285.238 390.315 286.035 390.327 286.078 c 390.477 286.639 390.416 286.653 390.695 287.312 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 397.523 288.354 m 399.632 290.85 l 399.435 291.086 399.158 290.839 398.315 291.299 c 397.995 291.474 397.202 291.518 396.828 291.685 c 396.759 291.688 396.896 291.645 396.828 291.685 c 396.657 291.73 395.911 292.102 395.737 292.071 c 395.738 292.109 395.737 292.071 y 395.257 292.205 394.808 292.223 394.323 292.205 c 393.96 292.202 393.877 292.125 392.647 291.883 c 392.332 291.82 391.512 291.563 391.163 291.501 c 390.849 291.438 390.202 291.309 389.921 291.206 c 389.85 291.171 389.892 291.359 389.921 291.206 c 391.846 288.357 l 391.971 288.415 391.709 288.273 391.846 288.357 c 392.344 288.558 393.106 288.988 393.642 289.055 c 394.225 289.164 394.846 289.139 395.422 289.071 c 395.466 289.069 396.36 288.921 396.403 288.908 c 396.948 288.74 396.847 288.687 397.523 288.354 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 392.109 280.742 m 390.126 278.145 l 390.335 277.919 390.599 278.18 391.464 277.761 c 391.792 277.602 392.586 277.597 392.968 277.449 c 393.037 277.449 392.898 277.486 392.968 277.449 c 393.141 277.412 393.905 277.077 394.077 277.117 c 394.078 277.079 394.077 277.117 y 394.563 277.007 395.012 277.011 395.496 277.053 c 395.858 277.073 395.937 277.155 397.154 277.456 c 397.465 277.534 398.272 277.832 398.617 277.91 c 398.927 277.989 399.567 278.15 399.843 278.266 c 399.912 278.305 399.879 278.115 399.843 278.266 c 397.779 281.018 l 397.657 280.954 397.912 281.107 397.779 281.018 c 397.292 280.793 396.552 280.325 396.02 280.232 c 395.443 280.094 394.821 280.089 394.243 280.129 c 394.199 280.128 393.395 280.375 393.352 280.386 c 392.684 280.557 392.79 280.559 392.109 280.742 c b* Q q 0.9973 0 0 1.0027 0 0 cm 0 0 0 1 k 1 j 0.333 w 2.613 M 398.847 282.231 m 402.226 280.176 l 402.434 280.404 402.15 280.642 402.491 281.537 c 402.621 281.876 402.555 282.664 402.67 283.055 c 402.663 283.124 402.638 282.983 402.67 283.055 c 402.691 283.23 402.957 284.017 402.903 284.185 c 402.94 284.189 402.903 284.185 y 402.969 284.675 402.925 285.121 402.84 285.597 c 402.787 285.954 402.698 286.025 402.288 287.205 c 402.182 287.506 401.812 288.279 401.703 288.614 c 401.596 288.915 401.378 289.535 401.237 289.798 c 401.193 289.862 401.386 289.847 401.237 289.798 c 398.668 287.506 l 398.743 287.391 398.567 287.629 398.668 287.506 c 398.937 287.043 399.471 286.351 399.611 285.832 c 399.8 285.273 399.634 284.664 399.646 284.088 c 399.651 284.044 399.52 283.247 399.513 283.203 c 399.402 282.526 399.246 282.806 398.891 282.231 c 398.847 282.231 l b* Q 390.911 283.702 m 390.866 284.057 391.088 284.589 391.088 284.944 c 391.044 284.899 391.531 284.5 391.487 284.456 c 391.62 284.456 391.797 284.411 391.797 284.456 c 392.151 285.165 391.974 284.811 392.24 285.653 c 392.282 285.787 392.196 286.894 392.284 287.072 c 392.329 287.116 392.86 286.284 392.86 286.185 c 392.86 285.83 393.259 287.116 393.392 286.761 c 393.525 286.495 393.082 285.564 393.304 285.387 c 393.658 285.121 393.88 285.786 393.835 286.141 c 394.013 285.431 393.791 284.899 393.614 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1 Tf 8 0 0 8 431.91 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD 0 Tc 0 Tw (9)Tj /TT3 1 Tf 7 0 0 7 126.24 726.66 Tm -0.0061 Tc 0.0234 Tw [(International Journal of Emergency Mental Health, Vol. 10, No. 1, pp. 9-26 2008 Chevron Publishing ISSN 1522-4821)]TJ /TT6 1 Tf 10 0 0 10 105.99 482.85 Tm 0.0212 Tc 0 Tw (Abstract: )Tj /TT7 1 Tf 4.371 0 TD 0.0223 Tc 0.125 Tw (Like siblings separated at birth, military psychology and police psychology have each)Tj -4.371 -1.299 TD -0.0037 Tc 0.0204 Tw (independently addressed the cognitive, perceptual, emotional, and behavioral aspects of men and women)Tj 0 -1.302 TD 0.1011 Tw [(performing extr)29.3(eme service in defense of their neighbor)14.3(hood or their country)56.2(.)-1( This article r)32.3(eviews the)]TJ 0 -1.299 TD -0.0093 Tc -0.0623 Tw (major areas of commonality in the work of military and police psychologists in the areas of crisis intervention)Tj T* -0.0002 Tc 0.125 Tw (and stress management, and provides practical strategies for handling these operational and clinical)Tj 0 -1.302 TD -0.0037 Tc 0.0804 Tw [(challenges. The article makes specific recommendations for how police and military psychologists can)]TJ 0 -1.299 TD 0.0032 Tc 0.1249 Tw [(c)5.2(r)27.2(oss-contribute to each other)-41.8()132.2(s fields for the overall enhanced pr)33.2(ovision of services to the men and)]TJ T* -0.0038 Tc -0.0241 Tw [(women who wear uniforms of all kinds. [International Journal of Emergency Mental Health, 2008, 10\(1\),)]TJ 0 -1.302 TD -0.0014 Tc 0.09 Tw (pp. 9-26].)Tj /TT1 1 Tf 9 0 0 9 127.26 342.99 Tm -0.0056 Tc -0.0167 Tw (Key words: )Tj /TT7 1 Tf 5.0767 0 TD -0.0049 Tc -0.0187 Tw [(Combat str)35.1(ess, critical incident str)31.8(ess, deadly for)35.1(ce, military psychology)51.8(, police psychology)51.8(, suicide)]TJ 12.2167 -1.3333 TD -0.0029 Tc 0 Tw (prevention)Tj ET /GS1 gs 65.49 115.755 m 298.5 115.755 l S BT 9 0 0 9 65.49 98.01 Tm /GS2 gs -0.0112 Tc -0.0625 Tw (Correspondence regarding this article may be directed to Laurence)Tj 0 -1.2233 TD 0.0029 Tc 0.1256 Tw [(Miller)106.2(, PhD, Plaza Four)106.2(, Suite 101, 399 W)86.2(.)-0.6( Camino Gar)36.2(dens)]TJ T* -0.0047 Tc -0.0033 Tw (Blvd., Boca Raton, Florida 33432; docmilphd@aol.com)Tj /F1 1 Tf 14 0 0 14 161.91 628.86 Tm 0.0039 Tc 0.1376 Tw [(Militar)-17.5(y Psychology and P)31.8(olice Psyc)6.1(hology:)]TJ -5.7321 -1.1443 TD -0.0004 Tc 0.1377 Tw (Mutual Contributions to Crisis Intervention and Stress Management)Tj /TT2 1 Tf 10 0 0 10 84 266.64 Tm -0.0039 Tc -0.0621 Tw (Like siblings separated at birth, military psychology and)Tj -1.8 -1.398 TD -0.0028 Tc 0.125 Tw (police psychology have each independently addressed the)Tj 0 -1.401 TD -0.0035 Tc 0.0641 Tw (cognitive, perceptual, emotional, and behavioral aspects of)Tj T* -0.0039 Tc 0.0725 Tw (men and women performing extreme service in defense of)Tj 0 -1.398 TD -0.0037 Tc -0.0375 Tw (their communities whether this be a specific neighborhood)Tj 0 -1.401 TD -0.0031 Tc 0.1228 Tw [(or the nation as a whole. In fact, many law enforcement)]TJ T* -0.0028 Tc -0.0432 Tw (officers have had military experience and many military ser-)Tj 0 -1.398 TD -0.0035 Tc 0.0106 Tw (vice members utilize tactics and strategies derived from pa-)Tj 0 -1.401 TD -0.0099 Tc -0.0625 Tw (trol and special unit policing to carry out their assigned duties.)Tj T* -0.0038 Tc 0.0492 Tw (So, when Ralph and Sammons \(2006\) recently commented)Tj 0 -1.398 TD -0.0084 Tc -0.0625 Tw (that the military is where much of the most progressive work)Tj 12 0 0 12 278.91 566.16 Tm -0.0335 Tc (Laurence Miller)Tj 10 0 0 10 229.41 553.5 Tm 0.0013 Tc -0.005 Tw (Independent Practice, Boca Raton, Florida)Tj 9.159 -28.686 TD -0.0027 Tc 0.0216 Tw (in psychology is taking place \(p. 375\), I felt it was time to)Tj 0 -1.398 TD -0.0032 Tc 0.045 Tw [(highlight the recent advances in police psychology \(Miller)35.8(,)]TJ 0 -1.401 TD -0.0036 Tc -0.0189 Tw (2006d, 2008\) that have both drawn from, and can contribute)Tj T* -0.0032 Tc -0.057 Tw (to, the work of our military colleagues and improve the clini-)Tj 0 -1.398 TD -0.0067 Tc -0.0625 Tw (cal and operational services we provide to men and women in)Tj 0 -1.401 TD -0.0028 Tc -0.045 Tw (uniform, wherever they may serve.)Tj /F1 1 Tf 11 0 0 11 321 155.19 Tm -0.0043 Tc 0.0409 Tw (Combat and Critical Incident Stress)Tj /TT2 1 Tf 10 0 0 10 339 131.85 Tm -0.0057 Tc -0.0627 Tw [(Clearly)66.3(, the most stressful aspect of both military service)]TJ -1.8 -1.401 TD -0.0034 Tc 0.093 Tw (and police work is the prospect of being injured or killed,)Tj 0 -1.398 TD -0.0029 Tc 0.085 Tw (closely followed by the act of killing another \(see below\).)Tj 0 -1.401 TD -0.0036 Tc -0.0414 Tw [(Other stresses have to do with enduring the loss of compatri-)]TJ T* -0.0003 Tc 0.125 Tw [(ots and generally confronting the human cruelty and car-)]TJ 0 -1.398 TD -0.0034 Tc 0.0844 Tw (nage of warfare and violent criminal activity \(Nordland &)Tj ET endstream endobj 93 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 95 0 obj << /Length 9737 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.0916 Tw [(10 )]TJ /TT3 1 Tf 2.2013 0 TD -0.0054 Tc 0.0937 Tw (Miller Military Psychology and Police Psychology)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0127 Tc -0.0625 Tw [(Gegax, 2004; Henry)62.3(, 2004\). 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Kardiner elaborated a)]TJ 0 -1.401 TD -0.0037 Tc -0.054 Tw (conceptualization of trauma he termed )Tj /TT7 1 Tf 15.225 0 TD -0.0043 Tc 0 Tw (physioneurosis )Tj /TT2 1 Tf 6.135 0 TD -0.0036 Tc -0.055 Tw (that is)Tj -21.36 -1.401 TD -0.0003 Tc 0.125 Tw (quite close to the modern concept of posttraumatic stress)Tj 0 -1.398 TD 0.0588 Tc 0.1401 Tw [(disorder \(AP)85.8(A, 2000\). )16.9(The features of Kardiner)-34.2()49.8(s)]TJ 0 -1.401 TD 0.0012 Tc 0.125 Tw (physioneurosis included: persistence of a startle response)Tj T* -0.0082 Tc -0.0626 Tw [(or irritability)63.8(, proneness to explosive behavior)36.8(, fixation on the)]TJ 0 -1.398 TD -0.0099 Tc -0.0625 Tw [(trauma, overall constriction of the personality)59.1(, and a disturbed)]TJ 0 -1.401 TD -0.0055 Tc (dream life, including vivid nightmares.)Tj 1.8 -2.001 TD -0.0038 Tc 0.0657 Tw [(The experiences of the Second )14.2(W)97(orld )17.2(W)94.1(ar contributed)]TJ -1.8 -1.398 TD -0.0032 Tc 0.125 Tw (surprisingly little to the development of new theories and)Tj 0 -1.401 TD -0.0035 Tc 0.0619 Tw (treatments for wartime trauma, aside from its relabeling as)Tj /TT7 1 Tf T* 0.0065 Tc 0.125 Tw (battle fatigue. )Tj /TT2 1 Tf 6.546 0 TD 0.007 Tc (In fact, resistance to the very concept of)Tj -6.546 -1.398 TD -0.0036 Tc -0.0137 Tw [(battle fatigue, with it)50.4(s implications of mental weakness and)]TJ 0 -1.401 TD 0.0455 Tw (lack of moral resolve, was widespread in both medical and)Tj T* -0.0117 Tc -0.0626 Tw [(military circles. )18.2(There was a war on, plenty of good G)117.3(.I.s were)]TJ 0 -1.398 TD -0.0032 Tc 0.0055 Tw [(getting killed and wounded, and the )50.7(Army had little sympa-)]TJ 0 -1.401 TD 0.0835 Tw (thy for the whinings of a few slackers and nervous nellies)Tj T* -0.0036 Tc 0 Tw (who couldnt buck up and pull their weight.)Tj 1.8 -1.998 TD -0.004 Tc -0.0347 Tw [(However)35(, it was becoming apparent that combat trauma)]TJ -1.8 -1.401 TD -0.0035 Tc 0.1206 Tw (and battle fatigue could take place in circumstances other)Tj T* -0.0032 Tc 0.0091 Tw [(than the actual battlefield. 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It has yet to be determined what the)]TJ T* 0.0004 Tc 0.1252 Tw [(eventual psychological casualty rate from the current )51.6(Af-)]TJ 0 -1.398 TD -0.0036 Tc 0.1128 Tw (ghanistan and Iraq wars will be, but a growing consensus)Tj 0 -1.401 TD -0.0032 Tc 0.0825 Tw (seems to be that psychological stress syndromes are being)Tj T* -0.0041 Tc -0.0625 Tw [(undertreated \(Clary)67.9(, 2005; Corbett, 2004; Galovski & L)49.9(yons,)]TJ 0 -1.398 TD -0.0169 Tc -0.0627 Tw [(2004; Nordland & Gegax, 2004; )18.9(T)74.9(yre, 2004\).)]TJ 1.8 -2.001 TD -0.0034 Tc -0.0307 Tw (In the civilian law enforcement and emergency services)Tj -1.8 -1.401 TD -0.0035 Tc -0.039 Tw [(fields, the equivalent of combat stress has come to be known)]TJ ET endstream endobj 96 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 98 0 obj << /Length 9490 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (11)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0035 Tc (as )Tj /TT7 1 Tf 1.086 0 TD -0.0032 Tc 0.0113 Tw (critical incident stress. )Tj /TT2 1 Tf 9.6 0 TD -0.0028 Tc 0.012 Tw (By this definition, a critical inci-)Tj -10.686 -1.398 TD -0.003 Tc 0.0789 Tw (dent is any event that has an unusually powerful, negative)Tj 0 -1.401 TD -0.0034 Tc 0.0472 Tw (impact on police personnel because it is above and beyond)Tj T* -0.0032 Tc -0.0265 Tw (the range of the ordinary stresses and hassles that come with)Tj 0 -1.398 TD -0.0081 Tc -0.0625 Tw [(the job. Major classes of critical incidents include: an officer-)]TJ 0 -1.401 TD -0.0027 Tc 0.125 Tw (involved shooting \(see below\), line-of-duty death, serious)Tj T* -0.0031 Tc -0.0592 Tw (injury to police personnel, serious multiple-casualty incident)Tj 0 -1.398 TD -0.0036 Tc 0.11 Tw (such as a school shooting or workplace violence incident,)Tj 0 -1.401 TD -0.0033 Tc -0.0084 Tw [(suicide of a police of)17.7(ficer)35.7(, traumatic death of children, or an)]TJ T* -0.0035 Tc 0.015 Tw [(event with excessive media interest. Recent times have ex-)]TJ 0 -1.398 TD -0.0013 Tc 0.125 Tw (panded exponentially the range and scope of horrific law)Tj 0 -1.401 TD -0.0035 Tc 0.0244 Tw (enforcement critical incidents to include acts of mass terror)Tj T* -0.0041 Tc -0.0621 Tw (and destruction involving multiple deaths of civilians, fellow)Tj 0 -1.398 TD -0.0028 Tc 0.0878 Tw (officers, and other emergency personnel \(Everly & Boyle,)Tj 0 -1.401 TD -0.0077 Tc -0.0625 Tw [(1999; Everly & Mitchell, 1997; Everly)58.3(, Flannery)61.3(, & Mitchell,)]TJ T* -0.0036 Tc 0.0399 Tw [(2000; Henry)59.4(, 2004; Karlsson & Christianson, 2003; Miller)35.4(,)]TJ 0 -1.398 TD -0.0162 Tc -0.0622 Tw [(2003; Mitchell & Everly)58.8(, 1996, 2003; Paton & Smith, 1999\).)]TJ /TT7 1 Tf 11 0 0 11 66 465.36 Tm 0.0074 Tc 0.1251 Tw [(Law Enfor)34.7(cement and Military S)29.2(t)-2(r)34.7(ess: V)72.9(ulnerabil-)]TJ 0 -1.1836 TD 0.008 Tc 0.1257 Tw (ity and Resilience Factors)Tj /TT2 1 Tf 10 0 0 10 84 432.66 Tm -0.0223 Tc -0.0622 Tw [( Some authorities \(Henry)55.7(, 2004; )19.7(V)57.9(iolanti, 1999\) have char)19.7(-)]TJ -1.8 -1.401 TD -0.0088 Tc -0.0625 Tw (acterized police work as civilian combat, and, as in all areas)Tj T* -0.0028 Tc -0.0019 Tw [(of psychology)63.2(, there are individual dif)18.2(ferences in the ability)]TJ 0 -1.398 TD 0.0264 Tc 0.125 Tw (to cope with combat stress and critical incident stress)Tj 0 -1.401 TD -0.0117 Tc -0.0621 Tw [(\(Almedom, 2005; Bonanno, 2004; Borders & Kennedy)63.3(, 2006;)]TJ T* -0.0124 Tc -0.0624 Tw [(Bowman, 1997; Carlier & Gersons, 1995; Carlier)32.6(, Lambert, &)]TJ 0 -1.398 TD -0.0035 Tc 0.0371 Tw [(Gersons, 1997; Corneil, Beaton, Murphy)62.5(, Johnson, & Pike,)]TJ 0 -1.401 TD -0.0209 Tc -0.0624 Tw [(1999; Friedman, Hamblin, Foa, & Charney)60.1(, 2004; Gentz, 1991;)]TJ T* -0.0294 Tc -0.0625 Tw [(Haas, 2007; Higgins & Leibowitz, 1999; Maddi, 2007; McNally)60.6(,)]TJ 0 -1.398 TD -0.0038 Tc -0.0581 Tw [(2003; Miller)35.2(, 1995, 1998, 2007b, 2007c; Nordland & Gegax,)]TJ 0 -1.401 TD -0.0174 Tc -0.0625 Tw [(2004; Orasanu & Backer)39.6(, 1996; )15.6(T)68.4(och, 2002; )18.6(W)50.4(inerman, 2006\).)]TJ T* -0.004 Tc 0 Tw (Increased )Tj /TT7 1 Tf 4.11 0 TD -0.0038 Tc 0.065 Tw (stress resilience)Tj /TT2 1 Tf 6.42 0 TD -0.0035 Tc 0.0658 Tw [( has been found to be associated)]TJ -10.53 -1.398 TD -0.005 Tc -0.0622 Tw (with higher IQ, especially verbal IQ, active problem-solving,)Tj 0 -1.401 TD -0.0074 Tc -0.062 Tw (utilization of productive denial, rationalization, compartmen-)Tj T* -0.0055 Tc [(talization, dispositional optimism, self-efficacy and self-con-)]TJ 0 -1.398 TD -0.0032 Tc -0.0021 Tw (fidence, and the ability to access and utilize social supports.)Tj 0 -1.401 TD -0.0041 Tc 0 Tw (Increased )Tj /TT7 1 Tf 4.089 0 TD -0.0036 Tc 0.045 Tw (vulnerability to stress)Tj /TT2 1 Tf 8.676 0 TD -0.0031 Tc 0.0462 Tw [( is associated with younger)]TJ -12.765 -1.401 TD 0.0439 Tw (age of service and fewer years of experience, lower educa-)Tj 0 -1.398 TD -0.0143 Tc -0.0625 Tw (tional level \(which is correlated with verbal intelligence\), prior)Tj 0 -1.401 TD 0 Tc 0.1249 Tw [(history of substance abuse or psychopathology)60(, prior his-)]TJ T* -0.0029 Tc 0.0343 Tw (tory of trauma, and poor social support systems.)Tj /TT7 1 Tf 11 0 0 11 66 119.34 Tm 0.0132 Tc 0.125 Tw (Psychological Interventions for Military Combat)Tj 0 -1.1809 TD 0.0013 Tc 0.1258 Tw [(S)32.2(t)0.1(r)28.6(ess: PIES and BICEPS)]TJ /TT2 1 Tf 10 0 0 10 84 86.64 Tm -0.0035 Tc 0.0038 Tw (Many of the principles of managing both combat stress)Tj -1.8 -1.398 TD 0.04 Tw (and law enforcement critical incident stress incorporate the)Tj 25.5 64.998 TD -0.0033 Tc 0.0255 Tw [(same basic elements. The primary goal is to depathologize)]TJ 0 -1.398 TD -0.0035 Tc 0.0019 Tw (these stress responses by framing them as normal responses)Tj 0 -1.401 TD 0.0144 Tc 0.125 Tw (of normal people to abnormal or extra-normal events)Tj T* -0.0185 Tc -0.0621 Tw [(\(Brickman, 1982; Campsie, Geller)38.5(, & Campsie, 2006; Mitchell)]TJ 0 -1.398 TD -0.0029 Tc 0.03 Tw [(& Everly)63.1(, 1996, 2003\), as well as to reinforce resilience by)]TJ 0 -1.401 TD -0.0034 Tc 0.0087 Tw (proper training and a positive service philosophy which has)Tj T* -0.0031 Tc 0.05 Tw (variously been characterized as )Tj /TT7 1 Tf 12.876 0 TD -0.0041 Tc 0 Tw (battlemind )Tj /TT2 1 Tf 4.533 0 TD -0.0044 Tc 0.0556 Tw [(\(Brusher)34.6(, 2007\))]TJ -17.409 -1.398 TD 0 Tw (or )Tj /TT7 1 Tf 1.149 0 TD -0.0039 Tc (mettle )Tj /TT2 1 Tf 2.745 0 TD -0.0034 Tc 0.0757 Tw [(\(Miller)35.6(, 2008\), among other terms. )17.7(T)70.4(o)0.2( this end,)]TJ -3.894 -1.401 TD -0.0031 Tc -0.0041 Tw [(beginning in )18.3(W)94.7(orld )15.3(W)97.7(ar I, the military has relied on the )]TJ /TT7 1 Tf 22.161 0 TD -0.0078 Tc 0 Tw (PIE)Tj /TT2 1 Tf -22.161 -1.401 TD 0.0035 Tc 0.125 Tw (concept \(Artiss, 1963; 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Dyregrov)56.6(, 1989,)]TJ T* -0.0113 Tc -0.0622 Tw [(1997; Everly & Boyle, 1999; Everly & Mitchell, 1997; Everly)]TJ 0 -1.398 TD -0.0416 Tc -0.0624 Tw [(et al., 2000; Miller)39.4(, 1995, 1998, 1999a, 1999b, 2000, 2005a, 2006b,)]TJ 0 -1.401 TD -0.019 Tc -0.0625 Tw [(2006d; 2007d; Mitchell & Everly)59(, 1996, 2003\).)]TJ 1.8 -2.001 TD -0.0035 Tc 0.0528 Tw (A CISD is a peer-led, clinician-guided, group process,)Tj -1.8 -1.398 TD 0.0007 Tc 0.125 Tw (although the individual roles of clinicians and peers may)Tj 0 -1.401 TD -0.0029 Tc -0.0309 Tw [(vary from setting to setting. )54.2(A)59.3( typical debriefing takes place)]TJ T* -0.0033 Tc -0.0488 Tw (within 24 to 72 hours of the critical incident and consists of a)Tj 0 -1.398 TD -0.0035 Tc 0.0211 Tw (single group meeting that lasts two to three hours, although)Tj 0 -1.401 TD -0.0054 Tc -0.0625 Tw (shorter or longer meetings may be dictated by circumstances.)Tj T* -0.0038 Tc 0.12 Tw (Where large numbers of workers are involved, such as in)Tj 0 -1.398 TD -0.0036 Tc -0.0358 Tw (mass disaster rescues or large-scale demobilizations, several)Tj 0 -1.401 TD -0.0029 Tc -0.06 Tw (debriefings may be held successively over the course of days)Tj T* -0.0192 Tc -0.0625 Tw (to accommodate all the personnel involved \(Everly & Mitchell,)Tj 0 -1.398 TD -0.0207 Tc -0.062 Tw [(1997; Mitchell & Everly)63.3(, 1996, 2003\).)]TJ 1.8 -2.001 TD -0.0034 Tc -0.0069 Tw [(The formal CISD process consists of seven key phases,)]TJ -1.8 -1.401 TD -0.0037 Tc 0.1029 Tw (designed to assist cognitive and emotional integration and)Tj 0 -1.398 TD -0.0035 Tc -0.0122 Tw [(mastery)62.5(, beginning with more objective and descriptive lev-)]TJ 0 -1.401 TD -0.0461 Tw (els of processing, progressing to the more personal and emo-)Tj T* -0.006 Tc -0.0622 Tw (tional, and back to the educative and integrative levels. 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The basic question is: What)Tj 0 -1.398 TD -0.0019 Tc 0.0525 Tw (did you do?)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0051 Tc -0.06 Tw (Thought phase)Tj /TT2 1 Tf 5.796 0 TD -0.0044 Tc -0.0621 Tw [(. Group members discuss their initial and)]TJ -7.596 -1.401 TD -0.0041 Tc 0.0036 Tw (subsequent thoughts during the critical incident: What was)Tj 0 -1.398 TD -0.0031 Tc 0.0366 Tw (going through your mind?)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0044 Tc 0.01 Tw (Reaction phase)Tj /TT2 1 Tf 6.09 0 TD -0.0034 Tc 0.0122 Tw [(. This begins to move the group from a)]TJ -7.89 -1.401 TD -0.0035 Tc 0.0569 Tw (predominantly cognitive mode of processing to a more ex-)Tj 0 -1.398 TD -0.0039 Tc 0.1061 Tw (pressive emotional level: What was the worst part of the)Tj 0 -1.401 TD -0.0023 Tc 0.02 Tw (incident for you?)Tj /TT7 1 Tf 27.3 65.199 TD -0.0049 Tc (Symptom phase)Tj /TT2 1 Tf 6.21 0 TD -0.0037 Tc 0.0229 Tw [(. This begins the movement back from)]TJ -8.01 -1.398 TD 0.0033 Tc 0.125 Tw (the predominantly emotional processing level toward the)Tj 0 -1.401 TD -0.0052 Tc -0.0624 Tw [(cognitive processing level. Participants are asked to describe)]TJ T* -0.0032 Tc -0.0064 Tw (their cognitive, physical, emotional, and behavioral signs of)Tj 0 -1.398 TD -0.0037 Tc 0.0594 Tw (distress: What have you been experiencing since the inci-)Tj 0 -1.401 TD 0.0181 Tc 0 Tw (dent?)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0012 Tc 0.125 Tw (Education phase)Tj /TT2 1 Tf 6.804 0 TD -0.0004 Tc [(. Continuing the move back toward)]TJ -8.604 -1.398 TD -0.0036 Tc 0.01 Tw (intellectual processing and normalization of the experience,)Tj 0 -1.401 TD -0.0051 Tc -0.0622 Tw (didactic information is provided about the nature of the stress)Tj T* -0.0033 Tc 0.0467 Tw (response and the expected physiological and psychological)Tj 0 -1.398 TD 0.01 Tw (reactions to critical incidents.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0019 Tc 0.125 Tw (Re-entry phase)Tj /TT2 1 Tf 6.126 0 TD -0.0008 Tc [(. During this wrap-up, any additional)]TJ -7.926 -1.401 TD -0.0035 Tc -0.035 Tw (questions or statements are addressed, referral for individual)Tj 0 -1.398 TD -0.0137 Tc -0.0625 Tw (follow-ups are made, and general group bonding is reinforced:)Tj 0 -1.401 TD -0.0038 Tc 0.0783 Tw (What have you learned?)Tj 1.8 -2.001 TD -0.0035 Tc 0.034 Tw (On this basic model, there have been a number of spe-)Tj -1.8 -1.398 TD -0.0097 Tc -0.0625 Tw (cialized adaptations of the CISD/CISM model for the military)Tj 0 -1.401 TD -0.0034 Tc -0.0393 Tw [(and law enforcement. )17.7(These include the Navy)50.6(s )]TJ /TT7 1 Tf 19.035 0 TD -0.004 Tc -0.04 Tw (special psy-)Tj -19.035 -1.401 TD 0.0082 Tw [(chiatric r)32(esponse intervention teams)]TJ /TT2 1 Tf 14.436 0 TD -0.0036 Tc 0.0097 Tw [( \(SPRINT\); the )53.1(Army)50.4(s)]TJ /TT7 1 Tf -14.436 -1.398 TD 0.0031 Tc 0.125 Tw (special medical augmentation response team-stress man-)Tj 0 -1.401 TD -0.0146 Tc 0 Tw (agement)Tj /TT2 1 Tf 3.291 0 TD -0.0145 Tc -0.0623 Tw [( \(SMAR)57.5(T)92.3(-SM\); the )51.2(Air Force)48.5(s )]TJ /TT7 1 Tf 11.994 0 TD -0.0139 Tc -0.0622 Tw [(critical incident str)31.1(ess)]TJ -15.285 -1.401 TD -0.0058 Tc 0 Tw (teams)Tj /TT2 1 Tf 2.31 0 TD -0.0036 Tc -0.0471 Tw [( \(CIST)50.4(; Campsie et al., 2006\); specialized )]TJ /TT7 1 Tf 16.494 0 TD -0.0049 Tc -0.0496 Tw [(law enfor)28.1(ce-)]TJ -18.804 -1.398 TD -0.0089 Tc -0.06 Tw (ment debriefing)Tj /TT2 1 Tf 6.114 0 TD -0.0081 Tc [( \(Bohl, 1995\); )]TJ /TT7 1 Tf 5.592 0 TD -0.0085 Tc (integrative debriefing)Tj /TT2 1 Tf 8.448 0 TD -0.0095 Tc -0.065 Tw [( \(Regehr)32.5(,)]TJ -20.154 -1.401 TD -0.0169 Tc -0.0614 Tw [(2001; Regehr & Bober)34.1(, 2004; Ruzek, 2002\); )]TJ /TT7 1 Tf 16.914 0 TD -0.065 Tw (line-of-duty death)Tj -16.914 -1.401 TD 0.0483 Tc 0 Tw (debriefing)Tj /TT2 1 Tf 4.599 0 TD 0.0494 Tc 0.125 Tw [( \(Mitchell & Levenson, 2006\); )]TJ /TT7 1 Tf 14.607 0 TD 0.0488 Tc 0 Tw (individual)Tj -19.206 -1.398 TD -0.0135 Tc (debriefings)Tj /TT2 1 Tf 4.356 0 TD -0.0127 Tc -0.0612 Tw [( \(Solomon, 1991, 1995\); )]TJ /TT7 1 Tf 9.51 0 TD -0.0129 Tc -0.0633 Tw (critical incident peer sup-)Tj -13.866 -1.401 TD -0.0112 Tc -0.06 Tw (port seminars)Tj /TT2 1 Tf 5.331 0 TD -0.0106 Tc -0.0616 Tw [( \(Solomon, 1995\); )]TJ /TT7 1 Tf 7.179 0 TD -0.0625 Tw (salutogenic debriefing )Tj /TT2 1 Tf 8.856 0 TD -0.0135 Tc 0 Tw (\(Dun-)Tj -21.366 -1.401 TD -0.0038 Tc 0.0727 Tw [(ning, 1999; S)17.2(tuhlmiller & Dunning, 2000; )14(V)64.4(iolanti, 2000\);)]TJ /TT7 1 Tf 0 -1.398 TD -0.0066 Tc -0.0625 Tw [(California Peace Officer Commission Peer Counselor T)50.4(rain-)]TJ 0 -1.401 TD -0.0143 Tc 0 Tw (ing )Tj /TT2 1 Tf 1.419 0 TD -0.0135 Tc -0.0625 Tw (\(Linden & Klein, 1986\); Salt Lake City Police Department)Tj /TT7 1 Tf -1.419 -1.401 TD -0.0042 Tc 0.1149 Tw [(T)57(raumatic Incident Corps)]TJ /TT2 1 Tf 10.464 0 TD -0.0035 Tc 0.1175 Tw [( \(TIC; Nielsen, 1991\); )]TJ /TT7 1 Tf 9.531 0 TD -0.0042 Tc 0.12 Tw [(the FBI)124.8(s)]TJ -19.995 -1.398 TD 0.0213 Tw (Critical Incident Stress Management Program)Tj /TT2 1 Tf 18.519 0 TD -0.003 Tc 0.0225 Tw [( \(McNally &)]TJ -18.519 -1.401 TD -0.0042 Tc 0.06 Tw (Solomon, 1999\); )Tj /TT7 1 Tf 7.029 0 TD -0.0038 Tc 0.0624 Tw [(and the US Secr)29.2(et Service)128.2(s Critical Inci-)]TJ -7.029 -1.401 TD -0.013 Tc -0.0596 Tw [(dent Support T)86(eam)]TJ /TT2 1 Tf 7.191 0 TD -0.0114 Tc -0.0628 Tw [( \(Britt, 1991\). )15.7(Whether explicitly or tacitly)60.6(,)]TJ -7.191 -1.398 TD -0.0036 Tc 0.0244 Tw (all of these programs incorporate important elements of the)Tj 0 -1.401 TD -0.0143 Tc -0.0625 Tw (military PIE/BICEPS and law enforcement CISD/CISM mod-)Tj T* -0.0036 Tc 0 Tw (els.)Tj /F1 1 Tf 11 0 0 11 309 168 Tm -0.0054 Tc 0.0262 Tw [(Psychotherapy f)13.7(or P)35.5(olice and Militar)-16.3(y Ser)-13.6(vice)]TJ 0 -1.0909 TD -0.0044 Tc 0 Tw (Members)Tj /TT2 1 Tf 10 0 0 10 327 132.66 Tm -0.0036 Tc -0.0288 Tw (Mental health services in law enforcement and the mili-)Tj -1.8 -1.401 TD -0.0053 Tc -0.0625 Tw (tary are not limited to critical incident or combat stress \(Budd)Tj T* -0.0122 Tc -0.0621 Tw [(& Kennedy)56.8(, 2006; Miller)32.8(, 2006d\). Police of)14.8(ficers and soldiers)]TJ 0 -1.398 TD -0.0029 Tc 0.0655 Tw (can be affected by a wide variety of problems that include)Tj 0 -1.401 TD -0.0033 Tc 0.0983 Tw (depression, suicidality \(see below\), substance abuse, work)Tj ET endstream endobj 102 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 104 0 obj << /Length 8632 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (13)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm 0.0017 Tc 0.125 Tw [(stress, and relationship problems. Here again police and)]TJ 0 -1.398 TD -0.0032 Tc 0.095 Tw (military psychologists can cross-contribute valuable thera-)Tj 0 -1.401 TD -0.0034 Tc 0.0458 Tw (peutic strategies for treating these specialized personnel.)Tj /TT7 1 Tf 11 0 0 11 66 661.35 Tm 0.0097 Tc 0.1255 Tw (Basic Principles of Psychotherapy with the)Tj 0 -1.1809 TD 0.0187 Tc 0.1268 Tw [()8.8(W)86.9(ounded W)86.9(a)2.4(rrior)]TJ /TT2 1 Tf 10 0 0 10 84 628.65 Tm -0.0029 Tc 0.125 Tw (Surveying the literature on both military and law en-)Tj -1.8 -1.401 TD -0.0031 Tc -0.0211 Tw [(forcement psychotherapy)62.9(, one is struck by the conver)14.9(gences)]TJ 0 -1.398 TD -0.0033 Tc 0.0439 Tw [(of theory and technique across both domains. Perhaps this)]TJ 0 -1.401 TD -0.0038 Tc 0.0864 Tw [(shouldn)17.2(t be surprising, however)35.2(, inasmuch as the law en-)]TJ T* -0.045 Tw (forcement stress has been characterized as civilian combat)Tj 0 -1.398 TD -0.0035 Tc -0.0544 Tw [(\()7.7(V)56.5(iolanti, 1999\) and both fields attract service members with)]TJ 0 -1.401 TD -0.0034 Tc 0.0231 Tw [(similar tough guy mindsets. In general, the effectiveness)]TJ T* -0.0027 Tc -0.0173 Tw (of any therapeutic strategy will be determined by the timeli-)Tj 0 -1.398 TD -0.0029 Tc 0.1133 Tw [(ness, tone, style, and intent of the intervention. 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Therapy should be)]TJ -15.519 -1.401 TD -0.0037 Tc 0.0975 Tw (goal-directed and focused on resolving specific adaptation)Tj 0 -1.398 TD -0.003 Tc 0.0431 Tw (and recovery issues related to the crisis at hand.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.004 Tc -0.035 Tw (Specify desired outcomes)Tj /TT2 1 Tf 9.945 0 TD -0.0025 Tc -0.0378 Tw [(. In the early phases, the clini-)]TJ -11.745 -1.401 TD -0.0032 Tc 0.083 Tw (cian may have to help the service member sort out, focus,)Tj 0 -1.398 TD -0.05 Tw (and operationalize his or her goals so that there will be a way)Tj 0 -1.401 TD -0.0035 Tc 0.03 Tw (of measuring whether the therapy process is accomplishing)Tj T* -0.0186 Tc 0 Tw (them.)Tj /TT7 1 Tf 1.8 -1.998 TD -0.0041 Tc -0.0416 Tw (Develop a general plan)Tj /TT2 1 Tf 9.204 0 TD -0.0033 Tc [(. 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Consistent)]TJ -18.669 -1.401 TD -0.0034 Tc 0.0912 Tw (with the overarching aim of military and law enforcement)Tj T* -0.0031 Tc 0.0775 Tw (psychotherapy as a strengthening, not weakening, process,)Tj 0 -1.398 TD -0.0097 Tc -0.0622 Tw (it is vital to assist the service member in identifying and utiliz-)Tj 0 -1.401 TD -0.0034 Tc -0.0095 Tw (ing his or her strengths and capabilities as coping resources.)Tj 1.8 -2.001 TD -0.0036 Tc -0.0129 Tw (Blau \(1994\) delineates a number of effective individual)Tj -1.8 -1.398 TD -0.0032 Tc 0.085 Tw (psychotherapeutic strategies for police officers that can be)Tj 0 -1.401 TD -0.003 Tc -0.0567 Tw (applied to therapy with military service members.)Tj /TT7 1 Tf 1.8 -2.001 TD 0.0069 Tc 0.125 Tw (Attentive listening.)Tj /TT2 1 Tf 7.764 0 TD 0.0078 Tc [( This includes good eye contact,)]TJ -9.564 -1.398 TD -0.0033 Tc 0.1217 Tw (appropriate body language, genuine interest, and interper-)Tj 0 -1.401 TD -0.0042 Tc 0.125 Tw (sonal engagement.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0031 Tc 0.1249 Tw [(Being ther)32.9(e with empathy)50.9(.)]TJ /TT2 1 Tf 10.716 0 TD -0.0014 Tc 0.1254 Tw [( )20(This conveys availability)61.6(,)]TJ -12.516 -1.398 TD 0.0031 Tc 0.125 Tw (concern, and awareness of the disruptive emotions being)Tj 0 -1.401 TD -0.0035 Tc -0.005 Tw [(experienced by the distressed service member)50.5(.)]TJ /TT7 1 Tf 1.8 -2.001 TD -0.0023 Tc 0 Tw (Reassurance.)Tj /TT2 1 Tf 5.34 0 TD -0.0005 Tc 0.125 Tw [( This means realistically reassuring the)]TJ -7.14 -1.398 TD -0.0034 Tc 0.0944 Tw (service member that routine matters will be taken care of,)Tj ET endstream endobj 105 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 107 0 obj << /Length 8847 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.0916 Tw [(14 )]TJ /TT3 1 Tf 2.2013 0 TD -0.0054 Tc 0.0937 Tw (Miller Military Psychology and Police Psychology)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0032 Tc 0.0256 Tw (deferred responsibilities will be handled by others, and that)Tj 0 -1.398 TD -0.004 Tc -0.0075 Tw (the member has administrative and command support.)Tj /TT7 1 Tf 1.8 -2.001 TD 0.08 Tw (Supportive counseling.)Tj /TT2 1 Tf 9.159 0 TD -0.0033 Tc 0.081 Tw [( This includes active listening,)]TJ -10.959 -1.401 TD -0.0034 Tc 0.0315 Tw (restatement of content, clarification of feelings, and valida-)Tj 0 -1.398 TD -0.0014 Tc 0 Tw (tion.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.001 Tc 0.125 Tw (Interpretive counseling)Tj /TT2 1 Tf 9.411 0 TD -0.0003 Tc [(. While still keeping the pro-)]TJ -11.211 -1.401 TD -0.0064 Tc -0.0625 Tw (cess short-term and focused on the immediate problem, inter-)Tj 0 -1.398 TD -0.0175 Tc (pretive counseling can stimulate the service member to explore)Tj 0 -1.401 TD -0.0028 Tc 0.0157 Tw (underlying emotional or psychodynamic issues that may be)Tj T* -0.0031 Tc -0.0041 Tw (intensifying a naturally stressful traumatic event \(Horowitz,)Tj 0 -1.398 TD -0.0516 Tc 0 Tw (1986\).)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0146 Tc [(Humor)99.4(.)-9.6( )]TJ /TT2 1 Tf 3.084 0 TD -0.011 Tc -0.0624 Tw [( )20.6(When used appropriately and respectfully)58(, thera-)]TJ -4.884 -1.401 TD -0.0033 Tc -0.013 Tw (peutic humor may help to bring a sense of balance, perspec-)Tj 0 -1.398 TD 0.0123 Tc 0.125 Tw (tive, and clarity to a world that seems to be warped by)Tj 0 -1.401 TD -0.0035 Tc 0.005 Tw (malevolence and horror \(Fry & Salameh, 1987; Fullerton et)Tj T* -0.0032 Tc -0.0625 Tw [(al., 1992; Henry)62.8(, 2004\), as long as the therapist keeps a lid on)]TJ 0 -1.398 TD (destructive types of self-mockery or inappropriate projective)Tj 0 -1.401 TD -0.005 Tw (hostility and is careful that well-intentioned kidding and ca-)Tj T* -0.0035 Tc 0.0306 Tw (joling not be interpreted as dismissive of the seriousness of)Tj 0 -1.398 TD -0.0039 Tc -0.0549 Tw [(the service member)-39.9()56.1(s)-0.6( plight.)]TJ /TT7 1 Tf 11 0 0 11 54 405.36 Tm 0.0144 Tc 0.125 Tw (Utilizing Cognitive Defenses)Tj /TT2 1 Tf 10 0 0 10 72 385.65 Tm -0.0089 Tc -0.0606 Tw [(In psychology)60.1(, )]TJ /TT7 1 Tf 5.874 0 TD -0.012 Tc -0.0625 Tw (defense mechanisms )Tj /TT2 1 Tf 8.04 0 TD -0.0112 Tc -0.0634 Tw (are the mental strata-)Tj -15.714 -1.401 TD -0.0093 Tc -0.0622 Tw (gems the mind uses to protect itself from unpleasant thoughts,)Tj 0 -1.398 TD -0.0037 Tc 0.0155 Tw [(feelings, impulses, and memories. 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If you)]TJ 0 -1.398 TD 0.0005 Tc 0.1249 Tw [(sustain a broken leg on the battlefield in the middle of a)]TJ 0 -1.401 TD -0.0032 Tc -0.027 Tw (firefight, the medic doesnt stop to clean the wound, put you)Tj T* -0.003 Tc -0.015 Tw (under anesthesia, set the bone, wrap you in a cast, and nurse)Tj 0 -1.398 TD -0.0031 Tc -0.0169 Tw [(you back to health. Hell no: he binds and braces the limb as)]TJ 0 -1.401 TD 0.001 Tc 0.125 Tw (best and as fast as he can with a dirty tree branch and)Tj 25.5 63.699 TD -0.0018 Tc (fishing tackle if necessary and helps you hobble out of)Tj 0 -1.398 TD -0.0053 Tc -0.06 Tw (there, double-time.)Tj 1.8 -2.001 TD -0.0029 Tc -0.0195 Tw [(In the same way)63.1(, for an acute psychological trauma, the)]TJ -1.8 -1.401 TD -0.0033 Tc 0.0156 Tw (proper utilization of psychological defenses can serve as an)Tj 0 -1.398 TD -0.0035 Tc 0.1225 Tw (important psychological splint or emotional field dressing)Tj 0 -1.401 TD 0.1039 Tw (that enables the person to function in the immediate post-)Tj T* -0.0033 Tc 0.1188 Tw (traumatic aftermath and eventually be able to resolve and)Tj 0 -1.398 TD -0.0119 Tw (integrate the traumatic experience when the luxury of thera-)Tj 0 -1.401 TD -0.0176 Tc -0.0621 Tw [(peutic time can be af)12.4(forded \(Janik, 1991; Miller)36.4(, 2008\). In fact,)]TJ T* -0.0039 Tc (in their regular military and law enforcement work, most ser-)Tj 0 -1.398 TD -0.0031 Tc 0.11 Tw (vice members usually need little help in applying defense)Tj 0 -1.401 TD -0.004 Tc -0.0184 Tw (mechanisms on their own.)Tj 1.8 -2.001 TD 0.0273 Tc 0.125 Tw (Examples of adaptive cognitive defense strategies)Tj -1.8 -1.398 TD -0.0086 Tc -0.0623 Tw [(\(Durham, McCammon, & )51.2(Allison, 1985; Henry)60.4(, 2004; )15.2(T)74.2(aylor)]TJ 0 -1.401 TD -0.0628 Tw [(& Brown, 1988; )9.1(T)74.2(aylor)36.4(,)-6.1( )15.1(W)95.2(ood, & Lechtman, 1983\) include:)]TJ /TT7 1 Tf 1.8 -2.001 TD -0.0043 Tc 0 Tw (Denial.)Tj /TT2 1 Tf 2.946 0 TD -0.0034 Tc 0.061 Tw [( Put it out of my mind; focus on other things;)]TJ -4.746 -1.398 TD -0.0036 Tc -0.015 Tw (avoid situations or people who remind me of it.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0042 Tc 0 Tw (Rationalization.)Tj /TT2 1 Tf 6.354 0 TD -0.0036 Tc 0.0306 Tw [( I had no choice; things happens for a)]TJ -8.154 -1.401 TD -0.0525 Tw (reason; it could have been worse; other people have it worse;)Tj 0 -1.398 TD -0.0034 Tc -0.0164 Tw (most people would react the way Im doing.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0043 Tc 0 Tw [(Displacement/pr)31.7(ojection. )]TJ /TT2 1 Tf 10.266 0 TD -0.0042 Tc 0.0109 Tw [( It was Command)52.8(s fault for)]TJ -12.066 -1.401 TD -0.0035 Tc 0.0575 Tw [(issuing such a stupid order; I didnt have the right backup;)]TJ 0 -1.398 TD -0.0025 Tc -0.0407 Tw (theyre all trying to blame me for everything.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0019 Tc 0.125 Tw (Refocus on positive attributes.)Tj /TT2 1 Tf 12.426 0 TD -0.0014 Tc [( Hey)64.6(, that miss was a)]TJ -14.226 -1.401 TD -0.0089 Tc -0.0625 Tw (fluke Im usually a great marksman; Im not going to let one)Tj 0 -1.398 TD -0.012 Tc -0.0616 Tw (mistake jam me up.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0038 Tc -0.0166 Tw (Refocus on positive behaviors.)Tj /TT2 1 Tf 12.06 0 TD -0.0034 Tc [( Okay)59.6(, Im going to get)]TJ -13.86 -1.401 TD -0.0033 Tc -0.0233 Tw (more training, increase my knowledge and skill so Ill never)Tj 0 -1.398 TD 0.0025 Tw (be caught with my pants down like this again.)Tj 1.8 -2.001 TD -0.0034 Tc 0.0119 Tw (Janik \(1991\) proposes that, in the short term, clinicians)Tj -1.8 -1.401 TD -0.0046 Tc -0.0621 Tw (actively support and bolster psychological defenses that tem-)Tj 0 -1.398 TD -0.0034 Tc -0.0057 Tw (porarily enable the service member to continue functioning.)Tj 0 -1.401 TD -0.0031 Tc 0.1 Tw (Just as a physical crutch is an essential part of orthopedic)Tj T* -0.0047 Tc -0.0625 Tw (rehabilitation when the leg-injured patient is learning to walk)Tj 0 -1.398 TD -0.003 Tc 0.0307 Tw (again, a psychological crutch is perfectly adaptive and pro-)Tj 0 -1.401 TD -0.0034 Tc 0.0595 Tw (ductive if it enables the service member to get back on his)Tj T* 0.055 Tw (emotional feet as soon as possible after a traumatic critical)Tj 0 -1.398 TD -0.003 Tc 0.0649 Tw [(incident. Only later)36(, when he or she is making the bumpy)]TJ 0 -1.401 TD -0.0051 Tc -0.0625 Tw (transition back to normal life, are potentially maladaptive de-)Tj T* -0.0034 Tc 0.0822 Tw [(fenses revisited as possible impediments to progress. It is)]TJ 0 -1.398 TD -0.0023 Tc 0.125 Tw (thus only when defenses are used inappropriately and for)Tj 0 -1.401 TD -0.0036 Tc -0.0404 Tw (too long past the point where the person should be walking)Tj T* 0.0044 Tc 0.125 Tw (on their own that they constitute a crutch in the un-)Tj 0 -1.398 TD -0.0031 Tc 0.0783 Tw (healthy and pejorative sense.)Tj ET endstream endobj 108 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 110 0 obj << /Length 8551 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (15)Tj 11 0 0 11 66 723.99 Tm -0.0046 Tc 0.047 Tw (Suicide Prevention and Intervention)Tj /TT2 1 Tf 10 0 0 10 84 700.65 Tm -0.0035 Tc 0.0699 Tw [(A)7.7(r)14.5(guably)62.5(, the single most devastating personal mental)]TJ -1.8 -1.401 TD -0.0031 Tc 0.0561 Tw [(health crisis is suicide. Considering that both military ser-)]TJ 0 -1.398 TD -0.0079 Tc -0.0622 Tw (vice and law enforcement are high-demand, high-stress fields)Tj 0 -1.401 TD -0.0035 Tc 0.0061 Tw (that attract personnel who tend to have high expectations of)Tj T* 0.0786 Tw (themselves, little tolerance for weakness, and a black-and-)Tj 0 -1.398 TD -0.0033 Tc 0.0789 Tw (white, all-or-nothing view of success and failure, it is per-)Tj 0 -1.401 TD -0.0032 Tc 0.105 Tw (haps not surprising that self-perceived failure may lead to)Tj T* -0.0036 Tc 0.0916 Tw [(depression and suicidality)62.4(, often commingled with alcohol)]TJ 0 -1.398 TD -0.0027 Tc 0.125 Tw [(and substance abuse. Police officers and military service)]TJ 0 -1.401 TD -0.0033 Tc -0.0138 Tw (members may become despondent and suicidal for a variety)Tj T* -0.0038 Tc -0.0622 Tw (of reasons related to their service or their family life \(Jones et)Tj 0 -1.398 TD -0.0175 Tc -0.0625 Tw [(al., 2007; Miller)33.5(, 2005b, 2006a, 2006d, 2007a; Norcross, 2003;)]TJ 0 -1.401 TD -0.0147 Tc -0.06 Tw (Rodgers, 2006\).)Tj /TT7 1 Tf 11 0 0 11 66 499.35 Tm 0.0081 Tc 0.1252 Tw [(Military and Law Enfor)32.6(cement Suicide: Basic)]TJ 0 -1.1809 TD 0.0241 Tc 0 Tw (Facts)Tj /TT2 1 Tf 10 0 0 10 84 466.65 Tm -0.003 Tc 0.0225 Tw (One area of disparity between military service and law)Tj -1.8 -1.401 TD -0.0033 Tc -0.0236 Tw [(enforcement may be in the actual rate of suicide. While sui-)]TJ 0 -1.398 TD -0.0034 Tc -0.0244 Tw (cide is the third leading cause of non-battle-related deaths in)Tj 0 -1.401 TD -0.0028 Tc 0.0249 Tw [(the military)63.2(, the actual suicide rate for military personnel is)]TJ T* -0.0094 Tc -0.0625 Tw [(lower than that of the nation as a whole \(Jones et al., 2007\). In)]TJ 0 -1.398 TD 0.0088 Tc 0.125 Tw (contrast, several surveys have identified the suicide rate)Tj 0 -1.401 TD -0.0034 Tc -0.0525 Tw (among police officers as higher than that of the general civil-)Tj T* -0.0074 Tc -0.0621 Tw [(ian population \(Cummings, 1996; Mohandi & Hatcher)37.6(, 1999;)]TJ 0 -1.398 TD -0.0035 Tc -0.0079 Tw [(Rudofossi, 2007; )17.7(V)61.7(iolanti, 1995, 1996\), although this is still)]TJ 0 -1.401 TD -0.0103 Tc -0.0625 Tw (controversial \(Curran, 2003\).)Tj 1.8 -2.001 TD -0.0023 Tc 0.125 Tw (Suicidal crises rarely occur in isolation, but are most)Tj -1.8 -1.398 TD -0.0033 Tc 0.0106 Tw (commonly seen in police officers with prior histories of de-)Tj 0 -1.401 TD -0.0034 Tc -0.0477 Tw (pression, or in those who have recently faced an overwhelm-)Tj T* 0.0078 Tc 0.125 Tw (ing crush of debilitating stressors, leading to feelings of)Tj 0 -1.398 TD 0.0001 Tc [(hopelessness and helplessness. )57.1(A)62.3( typical pattern consists)]TJ 0 -1.401 TD -0.0076 Tc -0.0625 Tw [(of a slow)61.4(, smoldering build-up of tension and demoralization,)]TJ T* -0.0054 Tc (which reaches a breaking point, and then rapidly nosedives)Tj 0 -1.398 TD -0.0258 Tc -0.0622 Tw (into a suicidal crisis \(Allen, 1986; Blau, 1994; Cummings, 1996;)Tj 0 -1.401 TD -0.0015 Tc 0.125 Tw [(Heiman, 1975; Henry)58.5(, 2004; Mohandie & Hatcher)37.5(, 1999;)]TJ T* -0.0034 Tc 0.0736 Tw [(Rodgers, 2006\). Similarly)59.6(, the most frequent precipitating)]TJ 0 -1.398 TD -0.0031 Tc 0.0043 Tw (factors in suicides among active-duty military personnel in-)Tj 0 -1.401 TD -0.0035 Tc 0.0592 Tw (clude feelings of shame, disgrace, isolation, worthlessness,)Tj T* 0.0037 Tc 0.125 Tw (and hopelessness related to service performance failures,)Tj 0 -1.398 TD -0.0034 Tc 0.037 Tw (disciplinary charges, professional and personal relationship)Tj 0 -1.401 TD -0.0035 Tc 0.02 Tw [(problems, substance abuse, or prior suicide attempts. Curi-)]TJ T* -0.0029 Tc 0.0371 Tw [(ously)63.1(, higher rates of suicide are seen in military personnel)]TJ 0 -1.398 TD -0.0071 Tc -0.0622 Tw (who work in security or law enforcement specialties \(Jones et)Tj 0 -1.401 TD -0.032 Tc -0.06 Tw (al., 2007\).)Tj 27.3 63.999 TD -0.0032 Tc -0.0523 Tw (Suicidal crises tend to be short, which means that timely)Tj -1.8 -1.398 TD -0.0145 Tc -0.0623 Tw [(intervention can literally make a life-or)15.5(-death dif)21.5(ference. )21.7(W)53.4(ith)]TJ 0 -1.401 TD -0.0033 Tc -0.0335 Tw (appropriate treatment, the vast majority of depressed, poten-)Tj T* -0.0015 Tc 0.125 Tw (tially suicidal persons improve considerably within a few)Tj 0 -1.398 TD -0.0038 Tc 0.005 Tw [(weeks \(Bongar)38.2(, 2002; Maris, 1981; Reinecke, )17.2(W)94(ashburn, &)]TJ 0 -1.401 TD -0.0036 Tc 0.0088 Tw [(Becker)17.4(-)19.3(W)74.4(eidman, 2007\). )17.6(This hardly means that depressed)]TJ T* 0.0639 Tw (moods and suicidal thoughts wont ever occur again, but a)Tj 0 -1.398 TD 0.0093 Tc 0.125 Tw (history of successful psychological treatment provides a)Tj 0 -1.401 TD -0.0032 Tc 0.0065 Tw (support resource that the individual can rely on if and when)Tj T* -0.0035 Tc 0 Tw [(the next crisis begins to brew)59.5(.)]TJ /TT7 1 Tf 11 0 0 11 321 563.34 Tm 0.01 Tc 0.1251 Tw [(P)6.4(r)31.8(eventing Military and Law Enfor)37.3(cement Suicide)]TJ /TT2 1 Tf 10 0 0 10 339 543.66 Tm -0.0036 Tc 0.1018 Tw (One of the persisting problems in dealing with police)Tj -1.8 -1.401 TD -0.0033 Tc -0.0611 Tw (officer suicide is the pervasive code of silence that character-)Tj T* -0.0217 Tw [(izes these personnel. Officers are reluctant to report depres-)]TJ 0 -1.398 TD -0.0034 Tc 0.1204 Tw [(sion or other problems for fear of being seen as weak or)35.6(,)]TJ 0 -1.401 TD -0.0032 Tc 0.0231 Tw (worse, of having restrictions placed on their activities \(e.g.,)Tj T* -0.0029 Tc 0.0718 Tw [(weapon carrying\). Fellow officers are equally reluctant to)]TJ 0 -1.398 TD 0.0253 Tc 0.125 Tw (rat out a distressed comrade, even though they may)Tj 0 -1.401 TD -0.0029 Tc 0.0044 Tw (strongly suspect he or she needs help. Thus, there is a need)Tj T* 0.016 Tc 0.125 Tw (for every law enforcement agency to have an efficient,)Tj 0 -1.398 TD -0.0033 Tc 0.085 Tw (nonstigmatized referral system for dealing with officers in)Tj 0 -1.401 TD -0.003 Tc 0.0993 Tw (psychological distress, so that any problems noted can re-)Tj T* 0.0181 Tc 0.125 Tw (ceive appropriate treatment in a supportive atmosphere)Tj 0 -1.398 TD -0.0199 Tc -0.0624 Tw [(\(Anderson, Swenson, & Clay)64.1(, 1995; Blau, 1994; Miller)34.1(, 2006d;)]TJ 0 -1.401 TD -0.0102 Tc -0.0622 Tw [(Rodgers, 2006; Russell & Biegel, 1990; )16.7(T)69.6(och, 2002\).)]TJ 1.8 -2.001 TD -0.0032 Tc -0.0068 Tw (In this regard, police psychologists can learn from their)Tj -1.8 -1.398 TD -0.0034 Tc 0.0886 Tw (military colleagues, who have been proactive in education)Tj 0 -1.401 TD -0.0035 Tc -0.0415 Tw (and training in regard to mental health issues such as depres-)Tj T* -0.0033 Tc -0.0355 Tw [(sion and suicide. One advantage of military organizations is)]TJ 0 -1.398 TD -0.0034 Tc 0.0738 Tw (that programs generated by the Department of Defense, or)Tj 0 -1.401 TD -0.0035 Tc -0.0106 Tw (even within an individual service branch, can achieve rapid,)Tj T* -0.0038 Tc 0.12 Tw (wide dissemination among service personnel, whereas the)Tj 0 -1.398 TD -0.0099 Tc -0.0621 Tw [(fragmented nature of literally thousands of municipal, county)59.1(,)]TJ 0 -1.401 TD -0.0034 Tc 0.0237 Tw (regional, state, and federal law enforcement agencies in the)Tj T* -0.0037 Tc -0.0092 Tw (U.S. makes such information-sharing a daunting task.)Tj 1.8 -1.998 TD -0.0144 Tc -0.0624 Tw [(One example of such a military program is the )48.7(Air Force)51.6(s)]TJ -1.8 -1.401 TD -0.0092 Tc -0.062 Tw (LINK \(Staal, 2001\), which stands for:)Tj /TT7 1 Tf 1.2 -2.001 TD -0.004 Tc 0.0467 Tw (L = Look )Tj /TT2 1 Tf 4.089 0 TD -0.0034 Tc 0.0475 Tw (for possible concerns or signs of distress.)Tj /TT7 1 Tf -4.089 -1.998 TD -0.0033 Tc 0.07 Tw (I = Inquire )Tj /TT2 1 Tf 4.875 0 TD -0.0038 Tc (about those concerns.)Tj /TT7 1 Tf -4.875 -2.001 TD -0.0037 Tc -0.02 Tw (N = Note )Tj /TT2 1 Tf 3.891 0 TD -0.0032 Tc (the level of risk.)Tj /TT7 1 Tf -3.891 -2.001 TD -0.0046 Tc (K = Know )Tj /TT2 1 Tf 4.329 0 TD -0.0034 Tc -0.021 Tw (the appropriate referral sources and strategies.)Tj ET endstream endobj 111 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 113 0 obj << /Length 8924 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.0916 Tw [(16 )]TJ /TT3 1 Tf 2.2013 0 TD -0.0054 Tc 0.0937 Tw (Miller Military Psychology and Police Psychology)Tj /TT2 1 Tf 10 0 0 10 72 722.64 Tm -0.0032 Tc 0.068 Tw [(Similarly)59.8(, the Navy and Marine Corps have adopted a)]TJ -1.8 -1.398 TD -0.0037 Tc 0.0023 Tw [(program called )50.4(AID LIFE \(Jones et al., 2007\), which stands)]TJ 0 -1.401 TD -0.0313 Tc 0 Tw (for:)Tj /TT7 1 Tf 1.2 -2.001 TD -0.0029 Tc -0.0234 Tw (A = Ask. )Tj /TT2 1 Tf 3.636 0 TD -0.0033 Tc -0.0249 Tw [(Are you thinking of hurting yourself? or Are)]TJ -1.836 -1.398 TD -0.0229 Tw [(you thinking about suicide? Remember that asking)]TJ 0 -1.401 TD -0.0035 Tc 0.07 Tw (a suicidal person about his or her thoughts will not)Tj T* -0.0029 Tc -0.0404 Tw (impel them to do it, and may in fact save their life.)Tj /TT7 1 Tf -1.8 -1.998 TD -0.0054 Tc -0.0614 Tw [(I = Inter)-5.4(vene immediately)54.6(. )]TJ /TT2 1 Tf 11.031 0 TD -0.062 Tw [(Don)21.6(t wait to take action. Let)]TJ -9.231 -1.401 TD -0.0034 Tc 0.0318 Tw (the person know that he or she is not alone and that)Tj T* -0.0039 Tc 0.069 Tw (someone cares enough to do something.)Tj /TT7 1 Tf -1.8 -1.998 TD -0.0034 Tc -0.0535 Tw [(D = Don)107.6(t keep it secr)32.6(et. )]TJ /TT2 1 Tf 9.906 0 TD -0.0031 Tc -0.055 Tw (Silence can only lead to increas-)Tj -8.106 -1.401 TD -0.0035 Tc 0.02 Tw (ing isolation and deterioration.)Tj /TT7 1 Tf -1.8 -2.001 TD -0.003 Tc 0.084 Tw [(L)22.2( = Locate help. )]TJ /TT2 1 Tf 7.521 0 TD -0.0035 Tc [(Seek out a superior of)17.5(ficer)38.5(, chaplain,)]TJ -5.721 -1.398 TD -0.0108 Tc -0.0621 Tw [(medical or mental health corpsman, crisis line worker)34.2(,)]TJ 0 -1.401 TD -0.0036 Tc 0.037 Tw (or other person who can intervene.)Tj /TT7 1 Tf -1.8 -2.001 TD -0.0069 Tc -0.0625 Tw [(I = Inform )]TJ /TT2 1 Tf 4.404 0 TD -0.007 Tc (the chain of command, so that they can arrange)Tj -2.604 -1.398 TD -0.0031 Tc 0.0187 Tw [(for long-term assistance, if necessary)59.9(.)]TJ /TT7 1 Tf -1.8 -2.001 TD 0.0112 Tw [(F = Find )]TJ /TT2 1 Tf 4.191 0 TD -0.0036 Tc 0.0117 Tw [(someone. Dont leave the person alone.)]TJ /TT7 1 Tf -4.191 -2.001 TD -0.003 Tc 0.0449 Tw (E = Expedite. )Tj /TT2 1 Tf 6.171 0 TD -0.0036 Tc 0.0467 Tw [(Get help now)62.4(.)-2.2( )32.7(Y)103.6(ou may save someone)50.4(s)]TJ -4.371 -1.398 TD -0.0394 Tc 0 Tw (life.)Tj /TT7 1 Tf 11 0 0 11 54 381.36 Tm 0.0152 Tc 0.1258 Tw [(W)92.8(arning Signs of Suicide)]TJ /TT2 1 Tf 10 0 0 10 72 361.65 Tm -0.0031 Tc 0.016 Tw (In turn, one area where the military can learn from law)Tj -1.8 -1.401 TD -0.0038 Tc 0.1107 Tw (enforcement is in the development and implementation of)Tj 0 -1.398 TD -0.0036 Tc 0.1242 Tw (specific protocols for prevention, response, and follow-up)Tj 0 -1.401 TD 0.06 Tw [(treatment of service members in distress. One of the most)]TJ T* -0.0038 Tc -0.0216 Tw (important prevention factors involves recognizing the warn-)Tj 0 -1.398 TD -0.0037 Tc 0.025 Tw [(ing signs of suicide \(Allen, 1986; Cummings, 1996; Miller)35.3(,)]TJ 0 -1.401 TD -0.0039 Tc -0.0028 Tw [(2005b, 2006a, 2006d; Mohandie & Hatcher)38.1(, 1999; Quinnet,)]TJ T* -0.008 Tc -0.0625 Tw (1998; Rodgers, 2006\), which include the following:)Tj /TT7 1 Tf 1.8 -1.998 TD -0.0042 Tc 0.0106 Tw [(Thr)31.8(eatening self.)]TJ /TT2 1 Tf 6.69 0 TD -0.0036 Tc [( )14.9(V)115.6(erbal self-threats can be direct: Id)]TJ -8.49 -1.401 TD -0.0031 Tc 0.0528 Tw [(be better off eating my gun; or indirect: Enjoy the good)]TJ T* -0.0027 Tc 0 Tw (times while you can they never last.)Tj /TT7 1 Tf 1.8 -1.998 TD -0.0043 Tc 0.1155 Tw [(Thr)31.7(eatening others.)]TJ /TT2 1 Tf 7.896 0 TD -0.0036 Tc 0.1167 Tw [( )-5.2( )17.4(V)112.6(erbal threats against others can)]TJ -9.696 -1.401 TD 0.009 Tw (be direct: I oughta cap that damn lieutenant for writing me)Tj T* 0.0744 Tw (up; or indirect: People with that kind of attitude deserve)Tj 0 -1.398 TD -0.0042 Tc -0.0279 Tw [(whatever)-40.2()55.8(s)-0.4( coming to them.)]TJ /TT7 1 Tf 1.8 -2.001 TD -0.0035 Tc 0.0017 Tw (Nothing to lose. )Tj /TT2 1 Tf 6.561 0 TD -0.0038 Tc 0.0019 Tw ( The service member behaves insubor-)Tj -8.361 -1.401 TD -0.0058 Tc -0.0627 Tw [(dinately)63.2(, without regard to career repercussions: Ill drink or)]TJ 0 -1.398 TD -0.0029 Tc 0.0975 Tw (smoke what I want, on or off duty what are they gonna)Tj 0 -1.401 TD 0.01 Tw [(do? Or he recklessly puts himself in danger on the job a)]TJ T* -0.004 Tc 0.0333 Tw (kind of passive suicide.)Tj /TT7 1 Tf 27.3 64.5 TD -0.0134 Tc -0.0601 Tw [(W)93.6(eapon surr)30.8(ender)106.6(.)]TJ /TT2 1 Tf 7.206 0 TD -0.0123 Tc -0.0622 Tw [( )16.5(The service member may fear his own)]TJ -9.006 -1.398 TD -0.0066 Tc -0.0625 Tw (impulses, but be reluctant to admit it: As long as Im on desk)Tj 0 -1.401 TD -0.005 Tc -0.0623 Tw [(duty this week, can I keep my gun in my locker? It)49(s a pain to)]TJ T* -0.0038 Tc 0.0325 Tw (lug it around the compound.)Tj /TT7 1 Tf 1.8 -1.998 TD -0.0035 Tc 0.06 Tw [(W)94.5(eapon overkill. )]TJ /TT2 1 Tf 7.05 0 TD -0.0033 Tc 0.0621 Tw [( )17.8(This is the opposite pattern: the ser)17.7(-)]TJ -8.85 -1.401 TD -0.0036 Tc -0.0569 Tw (vice member begins carrying more than one backup weapon,)Tj T* -0.0034 Tc -0.0444 Tw (or begins to keep especially powerful weapons in his vehicle)Tj 0 -1.398 TD -0.0035 Tc 0.0467 Tw (or on his person.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0032 Tc 0.0475 Tw (Cry for help. )Tj /TT2 1 Tf 5.784 0 TD -0.0033 Tc 0.0479 Tw (Things are getting too hairy out here; I)Tj -7.584 -1.401 TD -0.0029 Tc 0.0053 Tw (think I may need to check into the Bug Hilton to get my act)Tj 0 -1.398 TD 0.0061 Tc 0 Tw [(together)51.1(.)]TJ /TT7 1 Tf 1.8 -2.001 TD -0.004 Tc -0.021 Tw [(B)6(r)32(other)17(hood of the damned. )]TJ /TT2 1 Tf 11.286 0 TD -0.0034 Tc -0.022 Tw [( )6.6()6.6(Y)95.6(ou know the news story)]TJ -13.086 -1.401 TD -0.0035 Tc -0.0255 Tw (about that double-tour corporal who fragged his CO in Iraq?)Tj 0 -1.398 TD 0.0075 Tw (I know how that poor bastard felt.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0041 Tc 0.1025 Tw (Overwhelmed. )Tj /TT2 1 Tf 6.456 0 TD -0.003 Tc 0.1029 Tw (My wife just left me, my checks are)Tj -8.256 -1.401 TD -0.0035 Tc 0.0864 Tw (bouncing, Im drinking again, and the investigative ferrets)Tj 0 -1.398 TD -0.0028 Tc -0.0236 Tw [(are crawling up my butt. I just cant take all this.)]TJ /TT7 1 Tf 1.8 -2.001 TD -0.0033 Tc 0.125 Tw (No way out)Tj /TT2 1 Tf 4.776 0 TD -0.0024 Tc [(. If that Review Board burns me again,)]TJ -6.576 -1.401 TD -0.0047 Tc -0.0622 Tw [(that)55.3(s my last strike. No friggin)67.3( way Im going to jail for just)]TJ 0 -1.398 TD -0.0021 Tc -0.0124 Tw [(trying to do my job.)]TJ /TT7 1 Tf 1.8 -2.001 TD -0.0071 Tc -0.06 Tw (Final plans.)Tj /TT2 1 Tf 4.689 0 TD -0.0625 Tw [( The service member may be observed mak-)]TJ -6.489 -1.401 TD -0.0091 Tc (ing or changing a will, paying off debts, showing an increased)Tj 0 -1.398 TD -0.0034 Tc -0.01 Tw [(interest in religion, giving away possessions, making exces-)]TJ 0 -1.401 TD -0.0033 Tc 0.0755 Tw (sive donations to charities, and other end of days activi-)Tj T* 0.0028 Tc 0 Tw (ties.)Tj /TT7 1 Tf 11 0 0 11 309 317.34 Tm 0.0091 Tc 0.1255 Tw (Intervention with the Actively Suicidal Service)Tj 0 -1.1809 TD 0.029 Tc 0 Tw (Member)Tj /TT2 1 Tf 10 0 0 10 327 284.64 Tm -0.0034 Tc -0.0485 Tw (If the warning signs have been missed, the first chance a)Tj -1.8 -1.398 TD -0.0031 Tc 0.0035 Tw (clinician or peer may get to intervene with a depressed, sui-)Tj 0 -1.401 TD -0.0037 Tc -0.0625 Tw (cidal service member may be when the crisis is already peak-)Tj T* -0.0034 Tc -0.0325 Tw [(ing. The task now is to keep him or her alive long enough to)]TJ 0 -1.398 TD -0.0036 Tc -0.055 Tw (get appropriate follow-up care, and this can be accomplished)Tj 0 -1.401 TD -0.0033 Tc 0.1222 Tw (by adapting and applying some fundamental principles of)Tj T* -0.0036 Tc -0.0465 Tw (civilian and law enforcement crisis intervention \(Gilliland &)Tj 0 -1.398 TD -0.0038 Tc -0.0278 Tw (James, 1993; Greenstone & Leviton, 2001; Kleepsies, 1998;)Tj 0 -1.401 TD -0.0133 Tc -0.0622 Tw [(Miller)31.7(, 1998, 2006d; Rudd, Joiner)34.7(, Jobes, & King, 1999\).)]TJ /TT7 1 Tf 1.8 -2.001 TD -0.0035 Tc 0.0238 Tw (Define the problem. )Tj /TT2 1 Tf 8.496 0 TD -0.0041 Tc (While some personal crises relate)Tj -10.296 -1.398 TD -0.003 Tc -0.0616 Tw (to a specific incident, many evolve cumulatively as the result)Tj 0 -1.401 TD -0.0031 Tc 0.0255 Tw [(of a number of overlapping stressors, until they hit the pro-)]TJ T* -0.0036 Tc -0.0178 Tw [(verbial breaking point. In such cases, the service member)]TJ 0 -1.398 TD -0.0029 Tc -0.0032 Tw (himself may be unclear as to what exactly led to the present)Tj 0 -1.401 TD -0.003 Tc -0.0617 Tw [(suicidal state. By helping the member clarify what)51(s disturb-)]TJ ET endstream endobj 114 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 116 0 obj << /Length 9184 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (17)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0034 Tc 0.0011 Tw (ing him, nonlethal options and coping resources may be ex-)Tj 0 -1.398 TD 0.0045 Tc 0.125 Tw [(plored. It also shows that youre listening and trying to)]TJ 0 -1.401 TD 0.0162 Tc 0 Tw (understand.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0049 Tc 0.0296 Tw [(Ensur)28.1(e safety)49.1(.)-5.2( )]TJ /TT2 1 Tf 6.105 0 TD -0.0032 Tc 0.0275 Tw [(Y)104(oure not going to solve all of the ser)17.8(-)]TJ -7.905 -1.398 TD -0.0041 Tc 0.0929 Tw [(vice member)-40.1()55.9(s)-0.5( problems in this one encounter)49.9(.)-4.9( )17.6(What you)]TJ 0 -1.401 TD -0.0033 Tc -0.0431 Tw (want to do is make sure he survives this crisis so he can avail)Tj T* -0.0034 Tc 0.0681 Tw [(himself of whatever follow-up services are necessary)59.6(. For)]TJ 0 -1.398 TD -0.0031 Tc 0.0064 Tw [(n)6(o)6(w)59.9(, try to encourage the individual to put even a few short)]TJ 0 -1.401 TD -0.0035 Tc 0.1206 Tw (steps between the thought of a self-destructive action and)Tj T* -0.0033 Tc -0.0288 Tw [(its implementation. For example, if he has a gun, ask him to)]TJ 0 -1.398 TD -0.0029 Tc -0.005 Tw [(unload it or decock it. If he)54.1(s got a knife to his throat, see if)]TJ 0 -1.401 TD -0.003 Tc -0.0046 Tw [(hell put in on the table or at least lower it to his lap. If he)51(s)]TJ T* -0.0034 Tc 0.0568 Tw (holding a bottle of pills, encourage him to keep the cap on)Tj 0 -1.398 TD -0.0032 Tc -0.0145 Tw [(while youre talking. If he)50.8(s standing on a building ledge or)]TJ 0 -1.401 TD -0.003 Tc -0.0625 Tw (on a curb beside heavy traffic, maybe you can get him to take)Tj T* -0.0034 Tc 0.0175 Tw [(a step or two back. )50.6(And so on.)]TJ /TT7 1 Tf 1.8 -1.998 TD 0.0046 Tc 0.125 Tw (Provide support.)Tj /TT2 1 Tf 6.924 0 TD 0.0053 Tc [( Keep the conversation focused on)]TJ -8.724 -1.401 TD -0.0033 Tc 0.0807 Tw (resolving the present crisis, perhaps gently suggesting that)Tj T* -0.0031 Tc 0.0532 Tw (the larger issues can be dealt with later which subtly im-)Tj 0 -1.398 TD -0.0034 Tc -0.0529 Tw [(plies that there will indeed be a later)50.6(. In the meantime, just)]TJ 0 -1.401 TD -0.0215 Tc -0.0622 Tw (being there with empathy \(Blau, 1994\) with the service mem-)Tj T* -0.0036 Tc 0.045 Tw (ber helps.)Tj /TT7 1 Tf 1.8 -1.998 TD -0.0037 Tc -0.0283 Tw (Examine alternatives. )Tj /TT2 1 Tf 9.054 0 TD -0.0032 Tc -0.03 Tw (Often, people in crisis are so fix-)Tj -10.854 -1.401 TD -0.0035 Tc 0.0184 Tw (ated on their pain and hopelessness that their cognitive tun-)Tj T* -0.0031 Tc -0.0536 Tw [(nel vision prevents them from seeing any way out. )32.9(Y)104.1(ou want)]TJ 0 -1.398 TD -0.0033 Tc -0.0383 Tw (to gently expand the range of nonlethal options for resolving)Tj 0 -1.401 TD -0.0025 Tc 0.0523 Tw [(the crisis situation. )14.8(T)74.3(ypically)60.5(, )]TJ 12.3874 0 TD -0.0033 Tc 0.053 Tw (this takes one of two forms:)Tj /TT7 1 Tf -12.3874 -1.401 TD -0.0038 Tc 0.0083 Tw (accessing practical supports: )Tj /TT2 1 Tf 11.94 0 TD 0.0087 Tw (1\) persons or groups immedi-)Tj -11.94 -1.398 TD -0.0032 Tc -0.02 Tw (ately available to help the service member through the crisis)Tj 0 -1.401 TD -0.0024 Tc 0.125 Tw (until he or she can obtain follow-up care; and )Tj /TT7 1 Tf 19.806 0 TD -0.0045 Tc (2\) coping)Tj -19.806 -1.401 TD -0.0137 Tc 0 Tw (mechanisms )Tj /TT2 1 Tf 4.929 0 TD -0.0129 Tc -0.0625 Tw [( cognitive strategies, distracting activities, posi-)]TJ -4.929 -1.398 TD -0.0079 Tc -0.0621 Tw [(tive images and memories of family)61.1(, religious faith, or review)]TJ 0 -1.401 TD -0.0034 Tc 0.115 Tw (of successful handling of crises in the past, that show the)Tj T* -0.0035 Tc 0.015 Tw [(service member that hope is at least possible.)]TJ /TT7 1 Tf 1.8 -1.998 TD -0.0038 Tc 0.0986 Tw (Make a plan and obtain commitment. )Tj /TT2 1 Tf 15.999 0 TD -0.0035 Tc 0.1 Tw (Again, this in-)Tj -17.799 -1.401 TD -0.0037 Tc 0.0312 Tw (volves a combination of both practical supports and coping)Tj T* -0.0142 Tc -0.0625 Tw (mechanisms, as well as both short-term and longer-term plans.)Tj 0 -1.398 TD -0.0033 Tc -0.0405 Tw (Clarify what the service member will do in the next minutes,)Tj 0 -1.401 TD -0.0029 Tc -0.0004 Tw [(hours, and days, and what role other people will play)63.1(. Con-)]TJ T* -0.0031 Tc -0.055 Tw (firm that he or she agrees with the plan and set up a system to)Tj 0 -1.398 TD -0.0038 Tc -0.025 Tw (monitor and ensure its implementation.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0112 Tc -0.062 Tw [(Arrange for follow-up. )]TJ /TT2 1 Tf 9.249 0 TD -0.0115 Tc (When the acute crisis has passed,)Tj -11.049 -1.401 TD -0.0039 Tc -0.0625 Tw (referral to a mental health clinician is crucial for two reasons.)Tj 0 -1.398 TD -0.0066 Tc -0.0622 Tw (First, the military or police psychologist may have to perform)Tj 0 -1.401 TD -0.0031 Tc 0.1187 Tw (a fitness-for-duty evaluation to determine if the officer or)Tj 25.5 64.599 TD -0.0034 Tc 0.0818 Tw (service member is able to return to work; and if not, what)Tj 0 -1.398 TD -0.0046 Tc -0.0624 Tw [(treatment or other measures will be required to restore him or)]TJ 0 -1.401 TD -0.0031 Tc 0.1151 Tw [(her to active duty)59.9(. Second, specialized psychotherapeutic)]TJ T* -0.0033 Tc -0.0619 Tw (techniques may be applied; these may involve a combination)Tj 0 -1.398 TD -0.0036 Tc 0.023 Tw (of emotional exploration, realistic confidence-building, and)Tj 0 -1.401 TD -0.004 Tc -0.025 Tw (practical problem-solving approaches, sometimes combined)Tj T* -0.009 Tc -0.06 Tw (with medication.)Tj /F1 1 Tf 11 0 0 11 321 606 Tm 0.002 Tc 0 Tw (Killing)Tj /TT2 1 Tf 10 0 0 10 339 582.66 Tm -0.0033 Tc -0.011 Tw [(Many professionals undertake dirty)62.7(, demanding, and/or)]TJ -1.8 -1.401 TD -0.0036 Tc 0.0367 Tw (dangerous work firefighters, paramedics, rescue workers,)Tj T* -0.0039 Tc -0.0623 Tw [(airline pilots, and so on. But only police officers and soldiers)]TJ 0 -1.398 TD -0.0029 Tc 0.0593 Tw [(share the distinction of having the ability)63.1(, authority)60.1(, and in)]TJ 0 -1.401 TD -0.0031 Tc 0.0333 Tw (many cases the responsibility to kill other human beings as)Tj T* -0.0033 Tc 0.1095 Tw [(part of their job description. One difference is that while)]TJ 0 -1.398 TD -0.0031 Tc 0.0532 Tw (police officers may have to fire their weapon in the line of)Tj 0 -1.401 TD 0.1117 Tw [(duty)62.8(, killing another person in these circumstances is per)17.8(-)]TJ T* -0.0034 Tc 0.0396 Tw (ceived as a last resort and the overall emphasis is on main-)Tj 0 -1.398 TD -0.0093 Tc -0.0625 Tw [(taining order without the use of deadly force. Military service)]TJ 0 -1.401 TD -0.0032 Tc 0.0597 Tw [(members, however)35.8(, know that they are trained precisely to)]TJ T* -0.0029 Tc -0.0285 Tw (kill the enemy and may have to do so on a regular and large-)Tj 0 -1.398 TD -0.003 Tc 0.0665 Tw [(scale basis. Even for highly trained soldiers, the taking of)]TJ 0 -1.401 TD -0.0036 Tc -0.0122 Tw (human life can be a profound experience that can contribute)Tj T* 0.0994 Tw (to combat stress and behavioral problems \(Campsie et al.,)Tj 0 -1.398 TD -0.0176 Tc -0.0625 Tw [(2006; Clary)63.4(, 2005; Corbett, 2004; Friedman, 2004; Galvoski &)]TJ 0 -1.401 TD -0.0212 Tc [(L)58.6(yons, 2004; Jelinek, 2007; Murphy)65.8(, 2007; Nordland & Gegax,)]TJ T* -0.0033 Tc 0.028 Tw [(2004\). Thus, there may be much that law enforcement and)]TJ 0 -1.398 TD -0.0032 Tc 0.1055 Tw (the military can learn from each other in dealing with the)Tj 0 -1.401 TD -0.0033 Tc -0.015 Tw (effects of killing as a vocation.)Tj /TT7 1 Tf 11 0 0 11 321 283.35 Tm 0.0139 Tc 0.1251 Tw [(Deadly For)30.3(ce in Policing: Officer)13.9(-Involved)]TJ 0 -1.1809 TD 0.0353 Tc 0 Tw (Shootings)Tj /TT2 1 Tf 10 0 0 10 339 250.65 Tm -0.0032 Tc 0.0535 Tw (Among all public safety and emergency service work-)Tj -1.8 -1.401 TD -0.0033 Tc 0.0133 Tw (ers, the unique and ultimate symbol of the law enforcement)Tj 0 -1.398 TD -0.0022 Tc 0.125 Tw [(officer is the gun. No other nonmilitary service group is)]TJ 0 -1.401 TD -0.0047 Tc -0.0623 Tw (mandated to carry a lethal firearm as part of their daily equip-)Tj T* -0.0033 Tc 0.0867 Tw (ment, nor charged with the responsibility to use their own)Tj 0 -1.398 TD -0.0038 Tc -0.015 Tw (discretion and judgment in making split-second decisions to)Tj 0 -1.401 TD -0.0081 Tc -0.0621 Tw [(employ deadly force when called for)51.9(. )34.1(Y)102.1(e)-0.5(t, in reality)63.9(,)0.4( the firing)]TJ T* -0.0031 Tc 0.0192 Tw [(of one)53.9(s weapon in the line of duty is a rare event and most)]TJ 0 -1.398 TD -0.0034 Tc 0.0656 Tw (officers spend their entire careers without a single service-)Tj 0 -1.401 TD -0.0038 Tc 0.0525 Tw (related weapon discharge.)Tj 1.8 -2.001 TD -0.0117 Tc -0.0625 Tw [(A)80.5(vailable data indicate that about 600 criminals are killed)]TJ -1.8 -1.398 TD -0.0028 Tc 0.054 Tw [(each year by police officers in the United States. Some of)]TJ 0 -1.401 TD -0.0033 Tc 0.0856 Tw (these killings are in self-defense, some are accidental, and)Tj ET endstream endobj 117 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 120 0 obj << /Length 9919 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.0916 Tw [(18 )]TJ /TT3 1 Tf 2.2013 0 TD -0.0054 Tc 0.0937 Tw (Miller Military Psychology and Police Psychology)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0033 Tc 0.0518 Tw [(others are to prevent harm to others. The sources of stress)]TJ 0 -1.398 TD -0.0035 Tc 0.035 Tw (attached to an )Tj /TT7 1 Tf 5.859 0 TD -0.0038 Tc (officer-involved shooting )Tj /TT2 1 Tf 10.251 0 TD -0.0037 Tc 0.0375 Tw (\(OIS\) are multiple,)Tj -16.11 -1.401 TD -0.0034 Tc 0.0137 Tw [(and include the of)17.6(ficer)-39.4()53.6(s)-0.2( own psychological reaction to tak-)]TJ T* -0.0033 Tc 0.0068 Tw (ing a life, the responses of his or her law enforcement peers)Tj 0 -1.398 TD -0.0045 Tc -0.0619 Tw [(and the of)16.5(ficer)-40.5()58.5(s)-2.2( family)61.5(, rigorous examination by departmen-)]TJ 0 -1.401 TD 0.0052 Tc 0.125 Tw (tal investigators and administrators, possible disciplinary)Tj T* -0.0036 Tc 0.0482 Tw (action or change of assignment, possible criminal and civil)Tj 0 -1.398 TD 0.003 Tc 0.125 Tw (court action, and unwanted attention and sometimes out-)Tj 0 -1.401 TD -0.0035 Tc -0.0006 Tw [(right harassment by the media \(Baruth, 1986; Bohrer)35.5(, 2005;)]TJ T* -0.0156 Tc -0.0623 Tw [(Cloherty)65.4(, 2004; Henry)59.4(, 2004; Honig & Roland, 1998; Honig &)]TJ 0 -1.398 TD -0.0181 Tc -0.0622 Tw [(Sultan, 2004; Horn, 1991; IACP)107.9(, 2004; McMains, 1986a,1991;)]TJ 0 -1.401 TD -0.0125 Tc -0.062 Tw [(Miller)32.5(, 2006c, 2006d, 2008; Perrou & Farrell, 2004; Regehr &)]TJ T* -0.0151 Tc [(Bober)35.9(, 2005; Russell & Beigel, 1990; Zeling, 1986\).)]TJ /TT7 1 Tf 11 0 0 11 54 521.34 Tm 0.0157 Tc 0.125 Tw [(Shooting: Per)34.8(ceptual, Cognitive, and Behavioral)]TJ 0 -1.1809 TD 0.0296 Tc 0 Tw (Disturbances)Tj /TT2 1 Tf 10 0 0 10 72 488.64 Tm -0.0093 Tc -0.0623 Tw (Many police officers who have been involved in a deadly)Tj -1.8 -1.398 TD -0.0002 Tc 0.125 Tw (force shooting episode have described one or more alter-)Tj 0 -1.401 TD -0.0015 Tc (ations in perception, thinking, and behavior that occurred)Tj T* -0.0233 Tc -0.0622 Tw (during the event \(Artwohl, 2002; Honig & Roland, 1998; Honig)Tj 0 -1.398 TD -0.0135 Tc [(& Sultan, 2004; Solomon & Horn, 1986; )10.5(W)57.3(ittrup, 1986\); these)]TJ 0 -1.401 TD -0.006 Tc (are similar to those reported in military personnel following a)Tj T* -0.0033 Tc -0.0225 Tw [(firefight. Most of these reactions can be interpreted as natu-)]TJ 0 -1.398 TD -0.0036 Tc 0.1207 Tw (ral adaptive defensive reactions of an organism under ex-)Tj 0 -1.401 TD -0.0033 Tc 0.03 Tw (treme emergency stress)Tj 1.8 -2.001 TD -0.0044 Tc -0.0317 Tw (Most common are )Tj /TT7 1 Tf 7.365 0 TD -0.0037 Tc (distortions in time perception)Tj /TT2 1 Tf 11.601 0 TD -0.0026 Tc -0.0333 Tw [(. In the)]TJ -20.766 -1.398 TD -0.0033 Tc -0.0156 Tw (majority of these cases, service members recall the shooting)Tj 0 -1.401 TD -0.0035 Tc 0.0638 Tw (event as occurring in slow motion, although a smaller per-)Tj T* 0.0514 Tw (centage report experiencing the event as speeded up.)Tj /TT7 1 Tf 1.8 -1.998 TD 0.001 Tc 0.125 Tw (Sensory distortions )Tj /TT2 1 Tf 8.22 0 TD (are also common and most often)Tj -10.02 -1.401 TD -0.0056 Tc 0 Tw (involve )Tj /TT7 1 Tf 3.15 0 TD -0.0053 Tc -0.06 Tw (tunnel vision,)Tj /TT2 1 Tf 5.259 0 TD -0.0049 Tc -0.0621 Tw [( in which the service member is sharply)]TJ -8.409 -1.401 TD -0.0029 Tc -0.0517 Tw [(focused on one particular aspect of the visual field, typically)60.1(,)]TJ 0 -1.398 TD -0.0034 Tc 0.0119 Tw [(the suspect)53.6(s gun or weapon, while blocking out everything)]TJ 0 -1.401 TD -0.0022 Tc 0.0027 Tw [(in the periphery)60.8(. Similarly)63.8(, )]TJ /TT7 1 Tf 11.124 0 TD -0.0046 Tc 0.005 Tw (tunnel hearing)Tj /TT2 1 Tf 6.912 0 TD -0.0021 Tc 0.0046 Tw [( may occur)39.9(, in)]TJ -18.036 -1.401 TD -0.0003 Tc 0.125 Tw [(which the service member)-39.3()56.7(s)-0.5( auditory attention is focused)]TJ 0 -1.398 TD -0.004 Tc -0.0622 Tw (exclusively on a particular set of sounds, most commonly the)Tj 0 -1.401 TD -0.003 Tc 0.1252 Tw [(opponent)48(s voice, while background sounds are excluded.)]TJ T* -0.0036 Tc 0.081 Tw [(Sounds may also seem muf)14.4(fled or)35.4(, in a smaller number of)]TJ 0 -1.398 TD -0.0034 Tc -0.0128 Tw [(cases, louder than normal. Police officers have reported not)]TJ 0 -1.401 TD 0.0455 Tw [(hearing their own or other officers gunshots. Overall per-)]TJ T* -0.0028 Tc -0.052 Tw (ceptual clarity may increase or diminish.)Tj 1.8 -1.998 TD -0.0041 Tc 0.1084 Tw (Some form of )Tj /TT7 1 Tf 6.081 0 TD 0.11 Tw (perceptual and/or behavioral dissocia-)Tj -7.881 -1.401 TD -0.0039 Tc 0 Tw (tion )Tj /TT2 1 Tf 1.875 0 TD -0.003 Tc 0.0888 Tw [(may occur during the firefight. In extreme cases, the)]TJ -1.875 -1.401 TD -0.0035 Tc -0.0305 Tw (shooter will describe feeling as though he or she were stand-)Tj 0 -1.398 TD -0.0215 Tw (ing outside or hovering above the scene, observing it like it)Tj 0 -1.401 TD -0.0034 Tc 0.057 Tw [(was happening to someone else. In milder cases, the ser-)]TJ 25.5 65.799 TD 0.054 Tw (vice member may report that he or she just went on auto-)Tj 0 -1.398 TD 0.0257 Tw (matic, performing whatever actions were necessary with a)Tj 0 -1.401 TD -0.0036 Tc -0.0344 Tw [(sense of robotic detachment. Some shooters report intrusive)]TJ T* 0.0121 Tw (distracting thoughts during the scene, often involving loved)Tj 0 -1.398 TD -0.0034 Tc 0.0619 Tw [(ones or other personal matters, but it is not known if these)]TJ 0 -1.401 TD -0.0032 Tc 0.055 Tw (substantially affected their actions during the event.)Tj 1.8 -2.001 TD -0.0062 Tc 0 Tw (A )Tj /TT7 1 Tf 0.996 0 TD -0.0037 Tc 0.0317 Tw (sense of helplessness )Tj /TT2 1 Tf 8.655 0 TD -0.0034 Tc 0.0312 Tw (may occur during the shooting)Tj -11.451 -1.398 TD -0.0033 Tc -0.0355 Tw (exchange, but this may be underreported due to the potential)Tj 0 -1.401 TD -0.0036 Tc -0.0033 Tw [(stigma attached. )50.4(A)58.6( small proportion of service members re-)]TJ T* -0.0033 Tc 0.0045 Tw (port that they froze at some point during the event; again,)Tj 0 -1.398 TD -0.0037 Tc -0.0244 Tw [(either this is an uncommon response or personnel are under-)]TJ 0 -1.401 TD -0.003 Tc -0.0445 Tw [(standably reluctant to report it. In a series of interviews with)]TJ T* -0.0036 Tc 0.0232 Tw [(police of)14.4(ficers, )53.3(Artwohl \(2002\) found that most of these in-)]TJ 0 -1.398 TD -0.0034 Tc 0.0707 Tw (stances of freezing really represented the normal )Tj /TT7 1 Tf 20.895 0 TD -0.0046 Tc 0 Tw (action-)Tj -20.895 -1.401 TD -0.0043 Tc 0.095 Tw (reaction gap)Tj /TT2 1 Tf 5.13 0 TD -0.0035 Tc 0.0981 Tw [( in which officers make the decision to shoot)]TJ -5.13 -1.401 TD 0.0047 Tc 0.125 Tw (only after the suspect has engaged in clearly threatening)Tj 0 -1.398 TD -0.0033 Tc 0.0902 Tw [(behavior)50.7(. In most cases, this brief evaluation interval is a)]TJ 0 -1.401 TD -0.0035 Tc 0.0618 Tw (positive precaution, to prevent the premature shooting of a)Tj T* -0.0032 Tc -0.0295 Tw [(harmless citizen. But in situations where the ostensibly pru-)]TJ 0 -1.398 TD -0.0034 Tc 0.0456 Tw (dent action led to a tragic outcome, this cautious hesitation)Tj 0 -1.401 TD -0.003 Tc 0.0775 Tw (may well be viewed retrospectively as a fault: If I hadnt)Tj T* -0.0035 Tc -0.0623 Tw [(waited to see the bad guy draw)68.5(, maybe my partner would still)]TJ 0 -1.398 TD -0.0052 Tc -0.0622 Tw [(be alive. )15.8(V)117(ery similar situations are encountered by military)]TJ 0 -1.401 TD -0.0034 Tc 0.0216 Tw (occupation personnel who patrol potentially hostile civilian)Tj T* 0.0043 Tc 0 Tw (areas.)Tj /TT7 1 Tf 1.8 -1.998 TD -0.0165 Tc -0.0617 Tw (Disturbances in memory )Tj /TT2 1 Tf 9.519 0 TD -0.0159 Tc -0.0625 Tw (are commonly reported in shoot-)Tj -11.319 -1.401 TD -0.0036 Tc 0.0333 Tw [(ing exchanges. )50.4(About half of these involve impaired recall)]TJ T* -0.0034 Tc -0.0104 Tw (for at least some of the events during the shooting; the other)Tj 0 -1.398 TD -0.0032 Tc 0.0904 Tw (half involve impaired recall for at least part of the service)Tj 0 -1.401 TD -0.0035 Tc -0.0057 Tw [(member)-36.5()53.5(s)-0.4( own actions; this, in turn, may be associated with)]TJ T* -0.0557 Tw [(the going-on-automatic response. More rarely)59.5(, some aspects)]TJ 0 -1.398 TD -0.0026 Tc -0.0395 Tw (of the scene may be recalled with unusually clarity a )Tj /TT7 1 Tf 21.444 0 TD -0.0044 Tc 0 Tw (flash-)Tj -21.444 -1.401 TD -0.0505 Tw [(bulb memory)55.3(.)]TJ /TT2 1 Tf 5.346 0 TD -0.0032 Tc -0.0541 Tw [( Over a third of cases involve not a total loss of)]TJ -5.346 -1.401 TD 0.0117 Tc 0.125 Tw [(recall but a distortion of memory)62.7(, to the extent that the)]TJ 0 -1.398 TD -0.0036 Tc 0.0671 Tw [(shooter)-36.6()53.4(s)0.1( account of what happened dif)17.4(fers markedly from)]TJ 0 -1.401 TD 0.0037 Tc 0.125 Tw (the report of other observers at the scene; in such cases,)Tj T* -0.0026 Tc 0.0081 Tw (they may be accused of lying or deliberate distortion.)Tj /TT7 1 Tf 11 0 0 11 309 180.36 Tm 0.0111 Tc 0.1252 Tw [(Military and Law Enfor)32.9(cement Shooting and)]TJ 0 -1.1836 TD 0.0176 Tc 0.125 Tw (Post-Shooting Reaction Phases)Tj /TT2 1 Tf 10 0 0 10 327 147.66 Tm 0.0058 Tc (The stages of response that both soldiers and police)Tj -1.8 -1.401 TD -0.0035 Tc 0.0931 Tw (officers go through following a service-related taking of a)Tj T* -0.0037 Tc -0.0461 Tw [(human life are similar)53.3(. Campsie and colleagues \(2006\) sum-)]TJ 0 -1.398 TD -0.0038 Tc 0.0715 Tw [(marize Grossman)50.2(s \(1996\) description of five basic phases)]TJ 0 -1.401 TD -0.0034 Tc 0.082 Tw (often seen in response to killing in combat, which is quite)Tj T* -0.0031 Tc -0.0384 Tw (similar to the reactions reported by police officers in civilian)Tj 0 -1.398 TD -0.0086 Tc -0.0625 Tw [(law enforcement shootings \(Nielsen, 1991; )15.4(W)56.2(illiams, 1999\).)]TJ ET endstream endobj 121 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 123 0 obj << /Length 9445 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (19)Tj /TT2 1 Tf 10 0 0 10 84 722.64 Tm -0.0034 Tc 0.1055 Tw (The first phase occurs prior to the shooting itself and)Tj -1.8 -1.398 TD 0.0018 Tc 0.125 Tw (consists of )Tj /TT7 1 Tf 4.776 0 TD (concern about being actually able to pull the)Tj -4.776 -1.401 TD -0.0045 Tc 0 Tw (trigger)Tj /TT2 1 Tf 2.751 0 TD -0.0035 Tc 0.027 Tw [( when the time comes, of not freezing up and letting)]TJ -2.751 -1.401 TD -0.0043 Tc 0.0452 Tw [(one)52.7(s comrades down.)]TJ 1.8 -1.998 TD 0.0229 Tc 0.125 Tw (The second phase is the )Tj /TT7 1 Tf 10.929 0 TD 0.0234 Tc [(actual killing experience,)]TJ /TT2 1 Tf -12.729 -1.401 TD -0.0033 Tc 0.0474 Tw [(which is often done reflexively)59.7(, with the solider describing)]TJ T* -0.004 Tc 0.005 Tw (him/herself as going on automatic.)Tj 1.8 -1.998 TD 0.0069 Tc 0.125 Tw [(Elated at having survived the deadly encounter)36.9(, and)]TJ -1.8 -1.401 TD -0.0033 Tc 0.0266 Tw (having proven to himself that he can do the deed, there is a)Tj T* 0.0183 Tw (third stage of )Tj /TT7 1 Tf 5.535 0 TD -0.0045 Tc 0 Tw (exhilaration)Tj /TT2 1 Tf 4.839 0 TD -0.0042 Tc 0.019 Tw [( that comes from having popped)]TJ -10.374 -1.398 TD -0.0032 Tc 0.016 Tw [(my cherry and from having been able to put one)50.8(s training)]TJ 0 -1.401 TD -0.0029 Tc -0.0223 Tw [(into action. This exhilaration, fueled by the release of large)]TJ T* -0.0034 Tc 0.1175 Tw (amounts of adrenalin, can create a high or rush, which in)Tj 0 -1.398 TD -0.0107 Tc -0.0625 Tw [(some cases can give rise to combat addiction. Rodgers \(2006\))]TJ 0 -1.401 TD -0.0037 Tc 0.1012 Tw (describes the kind of adrenalin overdosing that can poi-)Tj T* -0.0034 Tc 0.1251 Tw [(son a police of)17.6(ficer)-39.4()56.6(s)-0.2( nervous system and lead to adverse)]TJ 0 -1.398 TD 0.025 Tw (reactions later on.)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0043 Tc -0.0475 Tw (Remorse and nausea,)Tj /TT2 1 Tf 8.409 0 TD -0.004 Tc -0.0488 Tw [( Grossman)50(s \(1996\) fourth phase )]TJ -10.209 -1.401 TD -0.0063 Tc -0.0622 Tw [(or what police psychologists \(Nielsen, 1991; )14.6(W)55.5(illiams, 1999\))]TJ 0 -1.398 TD -0.0034 Tc 0.0067 Tw (have called the )Tj /TT7 1 Tf 6.216 0 TD -0.0041 Tc 0.01 Tw (recoil and remorse)Tj /TT2 1 Tf 7.56 0 TD -0.0036 Tc 0.008 Tw [( phase follows the rush)]TJ -13.776 -1.401 TD -0.005 Tc -0.0622 Tw (of exhilaration and is often associated with a close-range kill;)Tj T* -0.003 Tc 0.0119 Tw (this may be more commonly experienced by police officers)Tj 0 -1.398 TD -0.0034 Tc 0.0639 Tw (who tend to confront their adversaries in close quarters, as)Tj 0 -1.401 TD -0.0033 Tc 0.1233 Tw (opposed to many soldiers who often fire from a distance.)Tj T* -0.0035 Tc 0.0487 Tw [(However)35.5(, there may be times when a soldier experiences a)]TJ 0 -1.398 TD -0.0031 Tc 0.0772 Tw (sense of identification, and empathy for the victim sets in,)Tj 0 -1.401 TD -0.0216 Tw (especially if the slain combatant was a fellow enemy soldier)Tj T* -0.0036 Tc 0.0778 Tw (just doing his job like I was, as opposed to an insurgent)Tj 0 -1.398 TD -0.0033 Tc -0.0625 Tw (bomber or assassin, for whom there will be far less sympathy)Tj 0 -1.401 TD -0.0052 Tc -0.0624 Tw [(or identification. The service member may be creeped out by)]TJ T* -0.0029 Tc -0.012 Tw (his own initial response: I enjoyed killing that guy way too)Tj 0 -1.398 TD -0.0037 Tc -0.0178 Tw (much is there something wrong with me?)Tj 1.8 -2.001 TD -0.0064 Tc -0.0622 Tw (For police officers, feelings of guilt or self-recrimination)Tj -1.8 -1.401 TD -0.0028 Tc -0.0405 Tw (may be especially likely in cases where the decision to shoot)Tj 0 -1.398 TD -0.0036 Tc -0.0039 Tw [(was less than clear)17.4(-cut or where the suspect)50.4(s actions essen-)]TJ 0 -1.401 TD -0.0028 Tc 0.0185 Tw (tially forced the hand of the officer into using deadly force,)Tj T* -0.0035 Tc 0.0237 Tw (such as in botched robberies, domestic disputes, or suicide-)Tj 0 -1.398 TD -0.0034 Tc 0.0398 Tw [(by-cop scenarios \(Kennedy)62.6(, Homant, & Hupp, 1998; Lind-)]TJ 0 -1.401 TD -0.0035 Tc -0.0499 Tw [(say & Dickson, 2004; Miller)35.5(, 2006d; Perrou & Farrell, 2004;)]TJ T* -0.0089 Tc -0.0624 Tw [(Pinizzotto, Davis, & Miller)36.1(, 2005\). Military service members)]TJ 0 -1.398 TD -0.0115 Tc (may be able to feel more justification in killing on a traditional)Tj 0 -1.401 TD -0.003 Tc 0.0728 Tw (battlefield, but may experience many of the same kinds of)Tj T* -0.0036 Tc 0.0059 Tw (self-recriminations in the nontraditional fighting arenas that)Tj 0 -1.398 TD -0.0062 Tc -0.0622 Tw [(have characterized most wars since the )20.8(V)65(ietnam era, in which)]TJ 0 -1.401 TD -0.0035 Tc 0.0618 Tw (targets are often elusive and ambiguous, with blurred lines)Tj T* -0.0038 Tc 0.0433 Tw (between combatants and civilians.)Tj 27.3 65.4 TD -0.0032 Tc -0.055 Tw (During this recoil/remorse phase, the military or law en-)Tj -1.8 -1.398 TD -0.0037 Tc -0.0407 Tw [(forcement service member may seem detached and preoccu-)]TJ 0 -1.401 TD -0.0032 Tc 0.12 Tw (pied, spacily going through the motions of his job duties,)Tj T* -0.0033 Tc 0.0072 Tw [(and operating on behavioral autopilot. He may be sensitive)]TJ 0 -1.398 TD -0.0035 Tc 0.085 Tw (and prickly to even well-meaning probing and congratula-)Tj 0 -1.401 TD -0.0032 Tc -0.0431 Tw [(tions by his peers \(How close was the enemy? W)77.8(ay to go,)]TJ T* -0.0024 Tc -0.0065 Tw (killer you got the bad guy\), and especially to accusatory-)Tj 0 -1.398 TD -0.0036 Tc -0.0217 Tw [(like interrogation and second-guessing from official investi-)]TJ 0 -1.401 TD -0.0031 Tc -0.03 Tw (gators or the media: Officer Jackson, did you really believe)Tj T* -0.0027 Tc -0.0282 Tw [(you were in fear for your life from a confused teenager? or)36.3(,)]TJ 0 -1.398 TD -0.0064 Tc -0.0623 Tw (Sergeant, did you really believe that civilian family was hid-)Tj 0 -1.401 TD -0.0033 Tc 0.0562 Tw (ing a group of insurgents?)Tj 1.8 -2.001 TD -0.0031 Tc -0.0519 Tw (Also, during this recoil phase, a variety of posttraumatic)Tj -1.8 -1.398 TD -0.0059 Tw (symptoms may be seen, most of which will resolve in a few)Tj 0 -1.401 TD -0.0028 Tc -0.0066 Tw (days or weeks )Tj /TT7 1 Tf 5.859 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.24 0 TD -0.0035 Tc -0.0079 Tw [( \(Anderson et al., 1995; Blum, 2000; Cohen,)]TJ -6.099 -1.401 TD -0.0038 Tc -0.0604 Tw [(1980; Geller)35.2(, 1982; Honig & Sultan, 2004; Russell & Beigel,)]TJ 0 -1.398 TD -0.0036 Tc -0.0415 Tw [(1990; )17.6(W)55.2(illiams, 1999\). Some of these will represent general)]TJ 0 -1.401 TD -0.0187 Tc -0.0625 Tw (posttraumatic reactions familiar to psychological trauma work-)Tj T* -0.0037 Tc 0.0168 Tw (ers \(Gilliland & James, 1993; Greenstone & Leviton, 2001;)Tj 0 -1.398 TD -0.0143 Tc -0.062 Tw [(Miller)36.7(, 1998, 2006d; Regehr & Bober)36.7(, 2004\), while others will)]TJ 0 -1.401 TD -0.0154 Tc -0.0625 Tw (have a specific military or law enforcement line-of-duty shoot-)Tj T* -0.0038 Tc 0.065 Tw (ing focus.)Tj 1.8 -1.998 TD 0.0036 Tc 0.125 Tw (Physical symptoms may include headaches, stomach)Tj -1.8 -1.401 TD 0.0051 Tc (upset, nausea, weakness and fatigue, muscle tension and)Tj T* -0.0036 Tc 0.02 Tw [(fasciculations, and changes in appetite and sexual function-)]TJ 0 -1.398 TD -0.003 Tc 0.0406 Tw [(ing. Sleep is typically impaired, with frequent awakenings)]TJ 0 -1.401 TD 0.0007 Tc 0.1249 Tw [(and often nightmares. )21.6(T)71.5(ypical posttraumatic reactions of)]TJ T* -0.0032 Tc -0.04 Tw [(intrusive imagery and flashbacks may occur)35.8(, along with pre-)]TJ 0 -1.398 TD -0.0095 Tc -0.0622 Tw [(monitions, distorted memories, and feelings of dj vu. Some)]TJ 0 -1.401 TD -0.0056 Tc -0.0625 Tw (degree of anxiety and depression is common, often accompa-)Tj T* -0.003 Tc -0.0585 Tw [(nied by panic attacks. There may be unnatural and disorient-)]TJ 0 -1.398 TD -0.0032 Tc 0.0908 Tw [(ing feelings of helplessness, fearfulness, and vulnerability)59.8(,)]TJ 0 -1.401 TD 0.0019 Tc 0.125 Tw [(along with self-second-guessing and guilt feelings. Sub-)]TJ T* -0.0029 Tc 0.013 Tw (stance abuse may be a risk.)Tj 1.8 -1.998 TD -0.0032 Tc 0.0064 Tw (Service members may show a pervasive irritability and)Tj -1.8 -1.401 TD -0.0036 Tc 0.075 Tw (low frustration tolerance, along with anger and resentment)Tj T* -0.003 Tc -0.0455 Tw [(toward the enemy)63(, the unit, the police department or military)]TJ 0 -1.398 TD -0.0035 Tc 0.12 Tw (branch in general, unsupportive peers or superiors, or un-)Tj 0 -1.401 TD -0.0214 Tw [(comprehending family members or civilians. Service mem-)]TJ T* -0.0623 Tw (bers may long for support, but at the same time reject helping)Tj 0 -1.398 TD -0.0062 Tc -0.061 Tw (efforts, leading to an alternating )Tj /TT7 1 Tf 12.534 0 TD -0.0071 Tc -0.065 Tw (control-alienation syndrome)Tj /TT2 1 Tf -12.534 -1.401 TD -0.0036 Tc -0.0519 Tw [(\(McMains, 1986b, 1991\) which is offputting and irritating to)]TJ T* 0.0048 Tc 0.125 Tw [(everyone concerned. )49.8(All this, combined with increased)]TJ 0 -1.398 TD -0.0027 Tc 0.0921 Tw (hypervigilance and hypersensitivity to threats of all kinds,)Tj 0 -1.401 TD -0.0033 Tc 0.0178 Tw (may result in overaggressive policing or soldiering, leading)Tj T* -0.0081 Tc -0.0624 Tw [(to abuse-of-force complaints \(Miller)36.9(, 2004\).)]TJ ET endstream endobj 124 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 126 0 obj << /Length 9224 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.0916 Tw [(20 )]TJ /TT3 1 Tf 2.2013 0 TD -0.0054 Tc 0.0937 Tw (Miller Military Psychology and Police Psychology)Tj /TT2 1 Tf 10 0 0 10 72 722.64 Tm -0.0039 Tc 0.0218 Tw [(Grossman)50.1(s \(1996\) final phase, )]TJ /TT7 1 Tf 12.72 0 TD -0.004 Tc 0.0225 Tw (rationalization and ac-)Tj -14.52 -1.398 TD 0 Tw (ceptance,)Tj /TT2 1 Tf 3.771 0 TD -0.0033 Tc 0.0439 Tw [( can be a long process and many veterans wrestle)]TJ -3.771 -1.401 TD -0.009 Tc -0.0622 Tw [(with their war experiences for a lifetime. Similarly)60(, in law en-)]TJ T* -0.0283 Tc -0.062 Tw [(forcement \(Miller)37.7(, 2006d, 2008; Nielsen, 1991; )16.8(W)54.5(illiams, 1999\),)]TJ 0 -1.398 TD 0.0042 Tc 0.125 Tw (as the officer begins to come to terms with the shooting)Tj 0 -1.401 TD -0.0034 Tc -0.0459 Tw (episode, a similar resolution or acceptance phase may ensue,)Tj T* 0.0672 Tw (wherein he or she assimilates the fact that the use-of-force)Tj 0 -1.398 TD -0.0032 Tc -0.005 Tw (action was necessary and justified in this particular instance)Tj 0 -1.401 TD -0.0033 Tc -0.0611 Tw (of the battle for survival that often characterizes law enforce-)Tj T* -0.0005 Tc 0.125 Tw [(ment deadly encounters. Even under the best of circum-)]TJ 0 -1.398 TD 0.0146 Tc (stances, resolution may be partial rather than total, and)Tj 0 -1.401 TD -0.0032 Tc 0.0828 Tw (psychological remnants of the experience may continue to)Tj T* -0.003 Tc -0.0116 Tw [(haunt the of)18(ficer periodically)63(, especially during future times)]TJ 0 -1.398 TD -0.0029 Tc -0.0446 Tw [(of crisis. But overall, he or she is eventually able to return to)]TJ 0 -1.401 TD -0.0036 Tc 0.015 Tw (work with a reasonable sense of confidence.)Tj 1.8 -2.001 TD -0.0032 Tc -0.0375 Tw [(In the worst case, suf)17.8(ficient resolution may never occur)35.8(,)]TJ -1.8 -1.398 TD -0.0035 Tc 0.0206 Tw (and the officer enters into a prolonged posttraumatic phase,)Tj 0 -1.401 TD -0.0622 Tw [(which may ef)17.4(fectively end his or her law enforcement career)50.4(.)]TJ T* -0.0029 Tc 0.0545 Tw (In less severe cases, a period of temporary stress disability)Tj 0 -1.398 TD -0.0031 Tc -0.005 Tw (allows the officer to seek treatment, to eventually regain his)Tj 0 -1.401 TD -0.0033 Tc -0.0569 Tw (or her emotional and professional bearings, and to ultimately)Tj T* -0.0094 Tc -0.0624 Tw [(return to the job. S)17.6(till other of)14.6(ficers return to work right away)59.6(,)]TJ 0 -1.398 TD -0.0029 Tc 0.0257 Tw (but continue to perform marginally or dysfunctionally until)Tj 0 -1.401 TD -0.0066 Tc -0.0622 Tw [(their actions are brought to the attention of superiors \(Bender)38.4(,)]TJ T* -0.028 Tc [(Jurkanin, Ser)14(gevnin, & Dowling, 2005; Miller)32(, 2004; Rudofossi,)]TJ 0 -1.398 TD -0.0033 Tc -0.0233 Tw [(2007\). Similar posttraumatic actions can be seen in military)]TJ 0 -1.401 TD -0.0111 Tc -0.062 Tw (service members \(Campsie et al., 2006\).)Tj /TT7 1 Tf 11 0 0 11 54 319.35 Tm 0.0191 Tc 0.1249 Tw [(Post-Shooting Psychotherapeutic S)27.3(trategies)]TJ /TT2 1 Tf 10 0 0 10 72 299.64 Tm 0.0234 Tc 0.125 Tw (One thing we know from civilian officer-involved)Tj -1.8 -1.398 TD -0.0033 Tc 0.0431 Tw (shootings is that most officers can be successfully returned)Tj 0 -1.401 TD -0.0032 Tc 0.0628 Tw [(to service with minimum psychological intervention. Psy-)]TJ T* -0.0035 Tc -0.0512 Tw (chotherapeutic strategies in these cases will follow the short-)Tj 0 -1.398 TD 0.0725 Tw (term intervention model described in a previous section of)Tj 0 -1.401 TD -0.0031 Tc 0.0378 Tw [(this article. Some specific principles apply to law enforce-)]TJ T* -0.0036 Tc -0.0028 Tw [(ment post-shooting stress \(Miller)38.4(, 2006c, 2006d, 2008\), and)]TJ 0 -1.398 TD -0.0029 Tc 0.0325 Tw (these can be productively adapted to the military setting.)Tj 1.8 -2.001 TD -0.0034 Tc -0.0265 Tw (First, review the facts of the case with the service mem-)Tj -1.8 -1.401 TD -0.0083 Tc -0.062 Tw [(ber)51.7(. )16.2(This allows for a relatively nonemotional narrative of the)]TJ 0 -1.398 TD -0.0033 Tc 0.1091 Tw [(traumatic event. But in the case of a shooting episode, it)]TJ 0 -1.401 TD -0.0031 Tc 0.0205 Tw [(serves a further)35.9(, specific function. Precisely because of the)]TJ T* -0.0035 Tc -0.025 Tw (cognitive and perceptual distortions that commonly occur in)Tj 0 -1.398 TD -0.0031 Tc -0.0381 Tw (these kinds of incidents, what may be particularly disturbing)Tj 0 -1.401 TD -0.003 Tc -0.0147 Tw (to the service member is the lack of clarity in his or her own)Tj T* -0.0034 Tc 0.0969 Tw [(mind as to the actual nature and sequence of events. Just)]TJ 0 -1.398 TD -0.0035 Tc 0.0946 Tw (being able to review what is known about the facts of the)Tj 25.5 65.298 TD -0.004 Tc -0.0625 Tw (case in a relatively safe and nonadversarial environment may)Tj 0 -1.398 TD -0.0027 Tc 0.125 Tw (provide a needed dose of mental clarity and sanity to the)Tj 0 -1.401 TD -0.0036 Tc 0.0444 Tw [(situation. Solomon \(1991, 1995\) describes one such thera-)]TJ T* -0.0034 Tc 0.045 Tw (peutic format as going over the incident frame by frame,)Tj 0 -1.398 TD -0.0038 Tc -0.0622 Tw (which allows the officer to verbalize the moment-to-moment)Tj 0 -1.401 TD -0.0032 Tc 0.0383 Tw (thoughts, perceptions, sensory details, feelings, and actions)Tj T* -0.0048 Tc -0.0622 Tw [(that occurred during the shooting incident. This format helps)]TJ 0 -1.398 TD -0.0035 Tc 0.0422 Tw (the officer become aware of, sort out, and understand what)Tj 0 -1.401 TD 0.0148 Tc 0 Tw (happened.)Tj 1.8 -2.001 TD -0.0079 Tc -0.0621 Tw [(Next, review the service member)-37.9()49.1(s)-0.1( thoughts and feelings)]TJ -1.8 -1.398 TD -0.0065 Tc [(about the shooting incident itself. This resembles the thought)]TJ 0 -1.401 TD -0.0032 Tc -0.0355 Tw (and reaction phases of a critical incident debriefing, but may)Tj T* 0.0806 Tw (not be as cut-and-dried as with a typical group debriefing.)Tj 0 -1.398 TD -0.0094 Tc -0.0621 Tw [(Remember)35.6(, killing another person represents a special kind of)]TJ 0 -1.401 TD -0.0057 Tc -0.0623 Tw (critical incident and it may take more than one attempt for the)Tj T* -0.0035 Tc 0.0379 Tw [(service member to productively untangle and reveal what)50.5(s)]TJ 0 -1.398 TD -0.0034 Tc -0.0496 Tw [(going on in his or her mind. Give him/her extra time or extra)]TJ 0 -1.401 TD 0.0041 Tc 0.125 Tw (sessions to express his/her thoughts and feelings, and be)Tj T* -0.0035 Tc 0.0795 Tw (sure to monitor the reaction so as not to encourage unpro-)Tj 0 -1.398 TD 0.0168 Tw [(ductive spewing or loss of control. One of the most impor-)]TJ 0 -1.401 TD -0.0029 Tc 0.016 Tw (tant things the military or police psychologist can do at this)Tj T* 0.0029 Tc 0.125 Tw (stage is to help modulate emotional expression so that it)Tj 0 -1.398 TD -0.0033 Tc 0.0156 Tw (comes as a relief, not as an added burden.)Tj 1.8 -2.001 TD -0.004 Tc -0.0625 Tw (Provide authoritative and factual information about psy-)Tj -1.8 -1.401 TD -0.0033 Tc -0.005 Tw (chological reactions to a law enforcement or military shoot-)Tj 0 -1.398 TD -0.0134 Tc -0.0622 Tw [(ing incident. The kinds of cognitive and perceptual distortions)]TJ 0 -1.401 TD -0.0033 Tc 0.0188 Tw (that take place during the incident, the posttraumatic symp-)Tj T* 0.001 Tc 0.1249 Tw (toms and disturbances, and the sometimes offputting and)Tj 0 -1.398 TD -0.0034 Tc 0.0378 Tw (distressing reactions of colleagues and family members are)Tj 0 -1.401 TD -0.0087 Tc -0.0625 Tw [(likely to be quite alien to the service member)-38.7()54.3(s)-0.3( ordinary expe-)]TJ T* -0.0032 Tc 0.1132 Tw (rience and might be interpreted by him or her as signs of)Tj 0 -1.398 TD 0.0395 Tw [(going soft or crazy)62.8(. Normalize these responses for the ser)17.8(-)]TJ 0 -1.401 TD -0.0089 Tc -0.0624 Tw [(vice member)36.1(, taking a somewhat more personal and individu-)]TJ T* -0.002 Tc 0.125 Tw (alistic approach than might be found in the typical group)Tj 0 -1.398 TD -0.0036 Tc 0.1243 Tw [(debriefing)53.4(s information-education phase. Often, just this)]TJ 0 -1.401 TD -0.0145 Tc -0.0625 Tw (kind of authoritative reassurance from a credible mental health)Tj T* -0.0031 Tc -0.0294 Tw (professional \(and in the military case, a superior officer\) can)Tj 0 -1.398 TD -0.0034 Tc -0.062 Tw [(mitigate the service member)-39.4()53.6(s)-0.9( anxiety considerably)62.6(.)]TJ 1.8 -2.001 TD -0.003 Tc 0.004 Tw [(Finally)63(,)0.2( provide the opportunity for follow-up services,)]TJ -1.8 -1.401 TD -0.0035 Tc 0.0415 Tw (which may include additional individual sessions, group or)Tj 0 -1.398 TD -0.0031 Tc -0.05 Tw [(family therapy)59.9(, referral to support services, possible medica-)]TJ 0 -1.401 TD -0.003 Tc 0.0227 Tw [(tion referral, and so on. For both military and law enforce-)]TJ T* -0.0034 Tc 0.0257 Tw (ment personnel, the seeking of psychological services must)Tj 0 -1.398 TD -0.0178 Tc -0.0622 Tw (be destigmatized and supported at all levels \(Blau, 1994; Fried-)Tj 0 -1.401 TD -0.003 Tc -0.0072 Tw [(man, 2004\). In addition, both military and police psycholo-)]TJ T* -0.0035 Tc 0.0734 Tw (gists can utilize the powerful social bonding forces of unit)Tj ET endstream endobj 127 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 129 0 obj << /Length 10064 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (21)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0035 Tc 0.1 Tw (cohesion and morale to bolster stress-resilience and aid in)Tj 0 -1.398 TD 0.0248 Tc 0.125 Tw (recovery from shootings and other traumatic incidents)Tj 0 -1.401 TD -0.0365 Tc -0.062 Tw [(\(Brusher)32.5(, 2007; Campsie et al., 2006; Maddi, 2007; Miller)35.5(, 2006d;)]TJ T* -0.0147 Tc -0.06 Tw (Rodgers, 2006\).)Tj 1.8 -1.998 TD -0.001 Tc 0.125 Tw (As with most cases of critical incident psychological)Tj -1.8 -1.401 TD -0.0033 Tc -0.054 Tw (intervention, follow-up psychotherapy for shooting episodes)Tj T* 0.0325 Tw (tends to be short-term, although additional services may be)Tj 0 -1.398 TD -0.0032 Tc -0.0119 Tw (sought later for other problems partially related or unrelated)Tj 0 -1.401 TD -0.0028 Tc 0.1145 Tw [(to the incident. Indeed, any kind of critical incident may)]TJ T* -0.0036 Tc -0.0489 Tw (often be the stimulus to explore other troublesome aspects of)Tj 0 -1.398 TD -0.0037 Tc 0.0957 Tw [(the service member)-39.7()56.3(s)-0.3( professional or personal life and the)]TJ 0 -1.401 TD -0.0033 Tc 0.0156 Tw (success in resolving the present incident with the psycholo-)Tj T* -0.0034 Tc -0.0506 Tw (gist may give the service member confidence to pursue these)Tj 0 -1.398 TD -0.0032 Tc -0.0539 Tw (other issues in an atmosphere of trust, thus potentially avoid-)Tj 0 -1.401 TD -0.0033 Tc 0.0507 Tw [(ing an adversarial disciplinary process \(Blau, 1994; Miller)35.7(,)]TJ T* -0.0353 Tc -0.06 Tw (1998, 2006d\).)Tj /F1 1 Tf 11 0 0 11 66 474 Tm -0.0001 Tc 0 Tw (Conclusions)Tj /TT2 1 Tf 10 0 0 10 84 450.66 Tm -0.0028 Tc -0.0275 Tw (Military and police psychology are siblings that need to)Tj -1.8 -1.401 TD -0.0144 Tc -0.0625 Tw [(be reintroduced and reunited, along with their firefighter)33.6(, para-)]TJ T* -0.0032 Tc 0.0942 Tw [(medic, rescue and recovery)62.8(, and other emer)17.8(gency services)]TJ 0 -1.398 TD -0.0034 Tc -0.0172 Tw [(cousins, to form a comprehensive system of clinical and op-)]TJ 0 -1.401 TD -0.0032 Tc 0.0025 Tw [(erational psychology for personnel in high-danger)38.8(, high-de-)]TJ T* -0.0035 Tc 0.1067 Tw [(mand professions. This article has offered a glimpse into)]TJ 0 -1.398 TD -0.0085 Tc -0.0625 Tw (that collaboration and cross-fertilization which will hopefully)Tj 0 -1.401 TD -0.0034 Tc 0.0245 Tw (spur further research into the art and science of helping our)Tj T* -0.0059 Tc -0.0623 Tw (men and women in uniform, whatever their stripes and colors)Tj 0 -1.398 TD -0.0051 Tc -0.06 Tw (may be.)Tj /F1 1 Tf 11 0 0 11 145.89 279.99 Tm 0.021 Tc 0 Tw (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 66 262.65 Tm -0.0037 Tc -0.0099 Tw [(Allen, S.W)86.3(. \(1986\). Suicide and indirect self-destructive be-)]TJ 1.2 -1.401 TD -0.0215 Tc -0.0625 Tw [(havior among police. In J.T)71.5(. Reese & H.A. Goldstein \(Eds.\),)]TJ /TT7 1 Tf 0 -1.398 TD -0.0034 Tc 0.125 Tw (Psychological Services for Law Enforcement )Tj /TT2 1 Tf 18.729 0 TD -0.0025 Tc (\(pp. 413-)Tj -18.729 -1.401 TD -0.013 Tc -0.0622 Tw [(417\). )16.5(W)93.8(ashington DC: USGPO.)]TJ -1.2 -1.8 TD -0.0036 Tc 0.0302 Tw [(Almedom, )53.6(A.M. \(2005\). 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Professionally administered critical inci-)Tj 1.2 -1.401 TD -0.0034 Tc -0.0338 Tw (dent debriefing for police officers. In M.I. Kunke & E.M.)Tj 0 -1.398 TD 0.095 Tw (Scrivner \(Eds.\), )Tj /TT7 1 Tf 6.69 0 TD -0.0038 Tc [(Police psychology into the 21)]TJ 5.8 0 0 5.8 520.95 375.99 Tm -0.0049 Tc 0 Tw (st)Tj 10 0 0 10 524.79 372.66 Tm -0.0039 Tc 0.1 Tw [( century)]TJ /TT2 1 Tf -19.179 -1.401 TD -0.0214 Tc -0.0625 Tw (\(pp. 169-188\). Hillsdale, NJ: Erlbaum.)Tj -1.2 -1.8 TD -0.0033 Tc -0.0097 Tw [(Bohrer)38.7(, S. \(2005\). )51(After firing the shots, what happens? )]TJ /TT7 1 Tf 22.161 0 TD -0.0078 Tc 0 Tw (FBI)Tj -20.961 -1.401 TD -0.0041 Tc -0.0268 Tw [(Law Enfor)31.9(cement Bulletin, )]TJ /TT2 1 Tf 10.785 0 TD -0.0037 Tc -0.029 Tw [(September)38.3(, pp. 8-13.)]TJ -11.985 -1.8 TD -0.0036 Tc 0.0526 Tw [(Bongar)38.4(, B. \(2002\). )]TJ /TT7 1 Tf 7.83 0 TD -0.0037 Tc 0.053 Tw (The suicidal patient: Clinical and legal)Tj -6.63 -1.398 TD -0.0043 Tc 0.1125 Tw [(standar)28.7(ds of car)31.7(e )]TJ /TT2 1 Tf 7.449 0 TD -0.008 Tc 0 Tw (\(2)Tj 5.8 0 0 5.8 415.74 297.99 Tm -0.0017 Tc (nd)Tj 10 0 0 10 421.56 294.66 Tm -0.0039 Tc 0.1146 Tw [( ed.\). )18(W)93.9(ashington, DC: )54(American)]TJ -8.856 -1.401 TD -0.0012 Tc 0.0722 Tw (Psychological Association.)Tj -1.2 -1.8 TD -0.0036 Tc 0.0193 Tw [(Bonanno, G)116.4(.A. \(2004\). Loss, trauma, and human resilience.)]TJ /TT7 1 Tf 1.2 -1.401 TD -0.0037 Tc -0.02 Tw (American Psychologist, 59, )Tj /TT2 1 Tf 11.091 0 TD -0.0048 Tc 0 Tw (20-28.)Tj -12.291 -1.8 TD -0.005 Tc -0.0621 Tw [(Borders, M.A. & Kennedy)61(, C.H. \(2006\). Psychological inter)13(-)]TJ 1.2 -1.398 TD 0.0024 Tc 0.125 Tw [(ventions after disaster in trauma. In Kennedy)62.4(, C.H. &)]TJ 0 -1.401 TD -0.0032 Tc 0.1091 Tw [(Zillmer)35.8(, E.A. \(Eds.\), )]TJ /TT7 1 Tf 8.721 0 TD -0.0039 Tc 0.1083 Tw (Military psychology: Clinical and)Tj -8.721 -1.401 TD -0.0261 Tc -0.0625 Tw (operational applications )Tj /TT2 1 Tf 9.336 0 TD [(\(pp. 331-352\). New )33.9(Y)105.1(ork: Guilford.)]TJ -10.536 -1.8 TD -0.0039 Tc -0.055 Tw (Bowman, M. \(1997\). )Tj /TT7 1 Tf 8.43 0 TD (Individual differences in posttraumatic)Tj -7.23 -1.398 TD 0.114 Tw (response: Problems with the adversity-distress connec-)Tj 0 -1.401 TD -0.0067 Tc 0 Tw (tion.)Tj /TT2 1 Tf 1.776 0 TD -0.0074 Tc -0.0616 Tw [( Mahwah, NJ: Erlbaum.)]TJ -2.976 -1.8 TD -0.0126 Tc -0.0624 Tw [(Brickman, P)107.4(.)-0.3( \(1982\). Models of helping and coping. )]TJ /TT7 1 Tf 19.914 0 TD -0.0145 Tc 0 Tw (American)Tj -18.714 -1.401 TD -0.006 Tc -0.06 Tw (Psychologist, 37,)Tj /TT2 1 Tf 6.705 0 TD -0.0066 Tc [( 368-384.)]TJ -7.905 -1.8 TD -0.0032 Tc 0.0156 Tw (Britt, J.M. \(1991\). U.S. Secret Service critical incident peer)Tj 1.2 -1.398 TD -0.0033 Tc 0.032 Tw (support team. In J. Reese, J. Horn & C. Dunning \(Eds.\),)Tj ET endstream endobj 130 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 132 0 obj << /Length 10623 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.0916 Tw [(22 )]TJ /TT3 1 Tf 2.2013 0 TD -0.0054 Tc 0.0937 Tw (Miller Military Psychology and Police Psychology)Tj /TT7 1 Tf 10 0 0 10 66 722.64 Tm 0.005 Tc 0.125 Tw (Critical incidents in policing )Tj /TT2 1 Tf 12.429 0 TD 0.0044 Tc 0.1257 Tw [(\(pp. 55-61\). )14.1(W)93.2(ashington)]TJ -12.429 -1.398 TD -0.0142 Tc -0.0625 Tw (DC: US Government Printing Office.)Tj -1.2 -1.8 TD -0.0036 Tc -0.0541 Tw [(Brusher)35.4(, E.A. \(2007\). Combat and operational stress control.)]TJ /TT7 1 Tf 1.2 -1.401 TD 0.0006 Tc 0.125 Tw (International Journal of Emergency Mental Health, 9,)Tj /TT2 1 Tf T* -0.0511 Tc 0 Tw (111-122.)Tj -1.2 -1.8 TD -0.0033 Tc -0.0269 Tw [(Budd, F)77.7(.C. & Kennedy)59.7(, C.H. \(2006\). Introduction to clinical)]TJ 1.2 -1.398 TD -0.0025 Tc 0.0818 Tw [(military psychology)63.5(. In Kennedy)63.5(, C.H. & Zillmer)36.5(, E.A.)]TJ 0 -1.401 TD 0.01 Tc 0 Tw (\(Eds.\), )Tj /TT7 1 Tf 3.12 0 TD 0.0087 Tc 0.125 Tw (Military psychology: Clinical and operational)Tj -3.12 -1.401 TD -0.0091 Tc 0 Tw (applications )Tj /TT2 1 Tf 5.019 0 TD -0.0087 Tc -0.0625 Tw [(\(pp. 21-34\). New )36.3(Y)101.5(ork: Guilford.)]TJ -6.219 -1.8 TD -0.0159 Tc [(Campsie, R.L., Geller)41.1(, S.K., & Campsie, M.E. \(2006\). Combat)]TJ 1.2 -1.398 TD -0.0029 Tc -0.0107 Tw [(stress. In Kennedy)60.1(, C.H. & Zillmer)36.1(, E.A. \(Eds.\), )]TJ /TT7 1 Tf 19.254 0 TD -0.0041 Tc 0 Tw (Military)Tj -19.254 -1.401 TD -0.0025 Tc 0.125 Tw (psychology: Clinical and operational applications )Tj /TT2 1 Tf 20.925 0 TD -0.0027 Tc 0 Tw (\(pp.)Tj -20.925 -1.401 TD -0.0282 Tc -0.0616 Tw [(215-240\). New )31.9(Y)100(ork: Guilford.)]TJ -1.2 -1.8 TD -0.0145 Tc -0.0621 Tw [(Carlier)36.5(, I.V)123.5(.E. & Gersons, B.P)105.5(.R. \(1995\). Partial PTSD: )15.6(The is-)]TJ 1.2 -1.398 TD -0.0034 Tc 0.0787 Tw (sue of psychological scars and the occurrence of PTSD)Tj 0 -1.401 TD -0.0029 Tc 0 Tw (symptoms. )Tj /TT7 1 Tf 4.566 0 TD -0.0038 Tc -0.0209 Tw (Journal of Nervous and Mental Disease, 183,)Tj /TT2 1 Tf -4.566 -1.401 TD -0.0511 Tc 0 Tw (107-109.)Tj -1.2 -1.8 TD -0.0174 Tc -0.0623 Tw [(Carlier)36.6(, I.V)126.6(.E., Lamberts, R.D., & Gersons, B.P)108.6(.R. \(1997\). Risk)]TJ 1.2 -1.398 TD -0.0025 Tc 0.125 Tw (factors for posttraumatic stress symptomatology in po-)Tj 0 -1.401 TD -0.003 Tc 0.0369 Tw [(lice of)18(ficers: )53.9(A)59.2( prospective analysis. )]TJ /TT7 1 Tf 14.769 0 TD -0.0043 Tc 0.0402 Tw (Journal of Nervous)Tj -14.769 -1.401 TD -0.0036 Tc -0.04 Tw (and Mental Disease, 185, )Tj /TT2 1 Tf 10.251 0 TD -0.0049 Tc 0 Tw (498-506.)Tj -11.451 -1.8 TD -0.0027 Tc -0.0401 Tw [(Clary)60.3(, M. \(2005\). )18.2(W)95.1(ar vets besieged by stress. )]TJ /TT7 1 Tf 18.21 0 TD -0.0045 Tc -0.04 Tw (South Florida)Tj -17.01 -1.398 TD -0.0038 Tc 0 Tw (Sun-Sentinel, )Tj /TT2 1 Tf 5.49 0 TD -0.0034 Tc -0.0167 Tw (March 28, pp. 1-2.)Tj -6.69 -1.8 TD -0.0081 Tc -0.0624 Tw [(Cloherty)60.9(, J.J. \(2004\). Legal defense of law enforcement of)15.9(fic-)]TJ 1.2 -1.401 TD -0.0031 Tc 0.0227 Tw [(ers in police shooting cases. In )17.8(V)134.1(.)-0.6( Lord \(Ed.\), )]TJ /TT7 1 Tf 18.375 0 TD -0.0041 Tc 0.025 Tw (Suicide by)Tj -18.375 -1.401 TD -0.0115 Tc -0.061 Tw (cop: Inducing officers to shoot )Tj /TT2 1 Tf 11.859 0 TD -0.0633 Tw [(\(pp. 85-150\). Flushing, NY)87.4(:)]TJ -11.859 -1.398 TD -0.0044 Tc -0.0625 Tw (Looseleaf Law Publications.)Tj -1.2 -1.8 TD -0.0106 Tc -0.0622 Tw [(Cohen, )55.4(A. \(1980\). Ive killed that man 10,000 times. )]TJ /TT7 1 Tf 20.964 0 TD -0.0114 Tc 0 Tw (Police,)Tj -19.764 -1.401 TD -0.008 Tc (3, )Tj /TT2 1 Tf 0.915 0 TD -0.015 Tc (4.)Tj -2.115 -1.8 TD -0.0034 Tc 0.0718 Tw [(Corbett, S. \(2004\). )17.5(The permanent scars of Iraq. )]TJ /TT7 1 Tf 19.836 0 TD -0.0063 Tc 0.0751 Tw [(New Y)83.7(ork)]TJ -18.636 -1.401 TD -0.0098 Tc -0.0625 Tw [(T)57.4(imes Magazine, )]TJ /TT2 1 Tf 6.75 0 TD -0.0087 Tc -0.0624 Tw [(February 15, pp. 34-41, 56-61.)]TJ -7.95 -1.8 TD -0.0029 Tc -0.0388 Tw [(Corneil, )15.3(W)106.9(., Beaton, R., Murphy)63.1(, S., Johnson, C., & Pike, K.)]TJ 1.2 -1.398 TD -0.005 Tc -0.0621 Tw (\(1999\). Exposure to traumatic incidents and prevalence of)Tj 0 -1.401 TD -0.0058 Tc -0.062 Tw (posttraumatic stress symptomatology in urban firefighters)Tj T* -0.0026 Tc 0.125 Tw (in two countries. )Tj /TT7 1 Tf 7.275 0 TD -0.0031 Tc (Journal of Occupational Health Psy-)Tj -7.275 -1.398 TD -0.01 Tc -0.0603 Tw [(chology)50(, 4, )]TJ /TT2 1 Tf 4.374 0 TD -0.0117 Tc 0 Tw (131-141.)Tj -5.574 -1.8 TD -0.0067 Tc -0.0621 Tw [(Cummings, J.P)104.3(. \(1996\). Police stress and the suicide link. )]TJ /TT7 1 Tf 22.224 0 TD -0.012 Tc 0 Tw (The)Tj -21.024 -1.401 TD -0.0071 Tc -0.06 Tw (Police Chief,)Tj /TT2 1 Tf 5.07 0 TD -0.0625 Tw [( October 1996, 85-96.)]TJ -6.27 -1.8 TD -0.0034 Tc 0.02 Tw (Curran, S. \(2003\). Separating fact from fiction about police)Tj 1.2 -1.401 TD -0.003 Tc 0 Tw (stress. )Tj /TT7 1 Tf 2.766 0 TD -0.004 Tc 0.065 Tw (Behavioral Health Management, 23, )Tj /TT2 1 Tf 15.015 0 TD -0.0047 Tc 0 Tw (1-2.)Tj -18.981 -1.8 TD 0.0017 Tc 0.125 Tw (Dunning, C. \(1999\). Postintervention strategies to reduce)Tj 1.2 -1.398 TD -0.0191 Tc -0.0624 Tw [(police trauma: )53(A)58.1( paradigm shift. In J.M. )17(V)61.1(iolanti & D. Paton)]TJ 25.5 62.598 TD -0.003 Tc 0 Tw (\(Eds.\), )Tj /TT7 1 Tf 2.955 0 TD -0.0038 Tc 0.062 Tw (Police trauma: Psychological aftermath of civil-)Tj -2.955 -1.398 TD -0.0102 Tc -0.06 Tw (ian combat )Tj /TT2 1 Tf 4.494 0 TD -0.0096 Tc -0.0628 Tw [(\(pp. 269-289\). Springfield, IL: Charles C Tho-)]TJ -4.494 -1.401 TD -0.0203 Tc 0 Tw (mas.)Tj -1.2 -1.8 TD -0.0086 Tc -0.062 Tw [(Durham, )15.9(T)77.2(.)15.2(W)87.4(., McCammon, S.L., & )51.9(Allison, E.J. \(1985\). )15.9(The)]TJ 1.2 -1.401 TD 0.0076 Tc 0.125 Tw (psychological impact of disaster on rescue personnel.)Tj /TT7 1 Tf 0 -1.398 TD -0.0037 Tc -0.035 Tw (Annals of Emergency Medicine, 14, )Tj /TT2 1 Tf 14.226 0 TD -0.0049 Tc 0 Tw (664-668.)Tj -15.426 -1.8 TD -0.0061 Tc -0.0626 Tw [(Dyregrov)56.9(, )53.8(A. \(1989\). Caring for helpers in disaster situations:)]TJ 1.2 -1.401 TD -0.0031 Tc 0.1024 Tw (Psychological debriefing. )Tj /TT7 1 Tf 10.596 0 TD -0.0041 Tc 0.105 Tw (Disaster Management, 2,)Tj /TT2 1 Tf 10.23 0 TD -0.0047 Tc [( 25-)]TJ -20.826 -1.401 TD -0.0625 Tc 0 Tw (30.)Tj -1.2 -1.8 TD -0.0033 Tc 0.0349 Tw [(Dyregrov)62.7(, )50.6(A. \(1997\). )14.6(The process in psychological debrief-)]TJ 1.2 -1.398 TD -0.0035 Tc 0 Tw (ing. )Tj /TT7 1 Tf 1.734 0 TD -0.0038 Tc -0.033 Tw [(Journal of T)50.2(raumatic S)32.2(t)3.2(r)29.2(ess, 10, )]TJ /TT2 1 Tf 12.792 0 TD -0.0049 Tc 0 Tw (589-605.)Tj -15.726 -1.8 TD -0.011 Tc -0.0627 Tw [(Everly)64(, G)118(.S., Jr)49(. & Boyle, S. \(1999\). Critical incident stress de-)]TJ 1.2 -1.401 TD -0.0032 Tc 0.06 Tw [(briefing \(CISD\): )50.8(A)59( meta-analysis. )]TJ /TT7 1 Tf 13.881 0 TD -0.0042 Tc 0.065 Tw (International Journal)Tj -13.881 -1.401 TD -0.0036 Tc -0.049 Tw (of Emergency Mental Health, 1, )Tj /TT2 1 Tf 12.726 0 TD -0.0049 Tc 0 Tw (165-168.)Tj -13.926 -1.8 TD -0.029 Tc -0.0626 Tw [(Everly)67(, G)118(.S., Jr)52(., Flannery)58(, R.B., Jr)52(., & Mitchell, J.T)73(. \(2000\). Criti-)]TJ 1.2 -1.398 TD -0.0041 Tc -0.0624 Tw [(cal incident stress management: )50(A)64.1( review of the literature.)]TJ /TT7 1 Tf 0 -1.401 TD 0.0326 Tw [(Aggr)32(ession and V)71(iolent Behavior)104(, 5, )]TJ /TT2 1 Tf 14.616 0 TD -0.0048 Tc 0 Tw (23-40.)Tj -15.816 -1.8 TD -0.0146 Tc -0.062 Tw [(Everly)66.4(, G)117.4(.S., Jr)57.4(. & Mitchell, J.T)75.4(. \(1997\). )]TJ /TT7 1 Tf 15.12 0 TD -0.0165 Tc -0.0622 Tw [(Critical incident str)28.5(ess)]TJ -13.92 -1.401 TD -0.0041 Tc 0.0083 Tw (management \(CISM\): A new era and standard of care in)Tj 0 -1.398 TD -0.0034 Tc -0.0353 Tw (crisis intervention. )Tj /TT2 1 Tf 7.611 0 TD -0.0369 Tw [(Ellicott City)62.6(, MD: Chevron.)]TJ -8.811 -1.8 TD -0.0035 Tc -0.0285 Tw [(Frazier)35.5(, F)77.5(.)-1.4( & )14.7(W)55.3(ilson, R.M. \(1918\). )17.8(The sympathetic nervous)]TJ 1.2 -1.401 TD -0.0032 Tc -0.0128 Tw (system and the irritable heart of soldiers. )Tj /TT7 1 Tf 17.205 0 TD -0.0042 Tc -0.015 Tw (British Medi-)Tj -17.205 -1.401 TD -0.0031 Tc -0.04 Tw (cal Journal, 2, )Tj /TT2 1 Tf 5.916 0 TD -0.0048 Tc 0 Tw (27-29.)Tj -7.116 -1.8 TD -0.0118 Tc -0.0623 Tw (Freud, S. \(1920\). Beyond the pleasure principle. In J. Strachey)Tj 1.2 -1.398 TD -0.0031 Tc -0.0566 Tw (\(Ed. & Transl.\), )Tj /TT7 1 Tf 6.39 0 TD -0.0037 Tc -0.0583 Tw (The standard edition of the complete psy-)Tj -6.39 -1.401 TD -0.0114 Tc -0.0609 Tw [(chological works of Sigmund Fr)27.6(eud )]TJ /TT2 1 Tf 13.866 0 TD -0.0107 Tc -0.0633 Tw [(\()9.5(V)124.3(ol. XVIII, pp. 7-64\).)]TJ -13.866 -1.401 TD -0.0121 Tc -0.0954 Tw [(New Y)104.1(ork: )-33.5(Norton.)]TJ -1.2 -1.8 TD -0.0035 Tc 0.0107 Tw [(Friedman, M.J. \(2004\). )50.4(Acknowledging the psychiatric cost)]TJ 1.2 -1.398 TD -0.0047 Tc -0.0025 Tw [(of war)52.3(.)-8.2( )]TJ /TT7 1 Tf 3 0 TD -0.0038 Tc -0.0033 Tw (New England Journal of Medicine, 351, )Tj /TT2 1 Tf 16.116 0 TD -0.0048 Tc 0 Tw (75-77.)Tj -20.316 -1.8 TD -0.003 Tc 0.0224 Tw [(Friedman, M.J., Hamblen, J.L., Foa, E.B., & Charney)60(, D.S.)]TJ 1.2 -1.401 TD -0.0033 Tc -0.0479 Tw (\(2004\). Fighting the psychological war on terrorism. )Tj /TT7 1 Tf 20.739 0 TD -0.0053 Tc 0 Tw (Psy-)Tj -20.739 -1.401 TD -0.004 Tc -0.0625 Tw (chiatry: Interpersonal and Biological Processes, 67, )Tj /TT2 1 Tf 20.691 0 TD -0.008 Tc 0 Tw (123-)Tj -20.691 -1.398 TD -0.0583 Tc (136.)Tj -1.2 -1.8 TD -0.0126 Tc -0.0628 Tw [(Fry)62.4(, )16.7(W)106.2(.)4.6(F)77.4(.)1( & Salameh, )16.7(W)106.2(.A. \(Eds.\) \(1987\). )]TJ /TT7 1 Tf 16.011 0 TD -0.0151 Tc -0.0625 Tw (Handbook of humor)Tj -14.811 -1.401 TD -0.0045 Tc 0.03 Tw [(and psychotherapy)49.5(.)-5.5( )]TJ /TT2 1 Tf 8.016 0 TD -0.004 Tc 0.0317 Tw (Sarasota: Professional Resource Ex-)Tj -8.016 -1.401 TD 0.0114 Tc 0 Tw (change.)Tj -1.2 -1.8 TD -0.0115 Tc -0.0624 Tw [(Fullerton, C.S., McCarroll, J.E., Ursano, R.J., & )18.6(W)53.3(right, K.M.)]TJ 1.2 -1.398 TD 0.027 Tc 0.125 Tw (\(1992\). Psychological responses of rescue workers:)Tj 0 -1.401 TD -0.0036 Tc 0.0384 Tw (Firefighters and trauma. )Tj /TT7 1 Tf 9.915 0 TD -0.0042 Tc 0.04 Tw (American Journal of Orthopsy-)Tj -9.915 -1.401 TD -0.0111 Tc -0.0589 Tw [(chiatry)51.7(,)-1.1( 62,)]TJ /TT2 1 Tf 4.344 0 TD -0.0115 Tc -0.06 Tw [( 371-378.)]TJ -5.544 -1.8 TD -0.0055 Tc -0.0624 Tw [(Galovski, )12.6(T)77.3(.)0.7( & L)48.5(yons, J.A. \(2004\). Psychological sequelae of)]TJ 1.2 -1.398 TD -0.0037 Tc -0.0019 Tw [(combat violence: )53.4(A)58.5( review of the impact of PTSD on the)]TJ ET endstream endobj 133 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 135 0 obj << /Length 11277 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (23)Tj /TT2 1 Tf 10 0 0 10 78 722.64 Tm -0.0033 Tc 0.0752 Tw [(veteran)53.7(s family)59.7(, and possible interventions. )]TJ /TT7 1 Tf 18.081 0 TD -0.0057 Tc 0 Tw [(Aggr)30.3(ession)]TJ -18.081 -1.398 TD -0.0037 Tc -0.0149 Tw [(and V)71.3(iolent Behavior)107.3(, 9, )]TJ /TT2 1 Tf 9.726 0 TD -0.0049 Tc 0 Tw (477-501.)Tj -10.926 -1.8 TD -0.0087 Tc -0.062 Tw [(Geller)36.3(,)-5.6( )18.2(W)104.1(.A. \(1982\). Deadly force: )18.2(What we know)60.3(.)-5.6( )]TJ /TT7 1 Tf 19.71 0 TD -0.0093 Tc -0.065 Tw (Journal of)Tj -18.51 -1.401 TD -0.0036 Tc 0.016 Tw (Police Science and Administration, 10, )Tj /TT2 1 Tf 15.801 0 TD -0.0049 Tc 0 Tw (151-177.)Tj -17.001 -1.8 TD -0.0032 Tc 0.0113 Tw (Gentz, D. \(1991\). The psychological impact of critical inci-)Tj 1.2 -1.401 TD -0.0073 Tc -0.0622 Tw (dents on police officers. In J. Reese, J. Horn & C. Dunning)Tj 0 -1.398 TD -0.003 Tc 0 Tw (\(Eds.\), )Tj /TT7 1 Tf 2.835 0 TD -0.0039 Tc -0.0625 Tw (Critical incidents in policing )Tj /TT2 1 Tf 11.409 0 TD -0.0048 Tc -0.063 Tw [(\(pp. 1)28.2(19-121\). )15.7(W)93(ash-)]TJ -14.244 -1.401 TD -0.0091 Tc -0.062 Tw (ington DC: US Government Printing Office.)Tj -1.2 -1.8 TD -0.0165 Tc -0.0625 Tw (Gilliland, B.E. & James, R.K. \(1993\). )Tj /TT7 1 Tf 14.364 0 TD -0.0171 Tc (Crisis intervention strat-)Tj -13.164 -1.401 TD -0.0079 Tc 0 Tw (egies )Tj /TT2 1 Tf 2.205 0 TD -0.014 Tc (\(2)Tj 5.8 0 0 5.8 108.21 588 Tm -0.0069 Tc (nd)Tj 10 0 0 10 113.94 584.64 Tm -0.0077 Tc -0.062 Tw [( ed.\). Pacific Grove, CA: Brooks/Cole.)]TJ -4.794 -1.8 TD -0.0033 Tc 0.025 Tw (Greenstone, J.L. & Leviton, S.C. \(2001\). )Tj /TT7 1 Tf 16.599 0 TD -0.0038 Tc 0.0275 Tw (Elements of crisis)Tj -15.399 -1.398 TD -0.0037 Tc 0.1178 Tw (intervention: Crises and how to respond to them.)Tj /TT2 1 Tf 20.259 0 TD -0.0057 Tc 0.12 Tw [( New)]TJ -20.259 -1.401 TD -0.0043 Tc -0.0567 Tw [(Y)102.9(ork: W)93.5(adsworth.)]TJ -1.2 -1.8 TD -0.0037 Tc 0.03 Tw (Grossman, D.A. \(1996\). )Tj /TT7 1 Tf 9.924 0 TD -0.0038 Tc 0.0313 Tw (On killing: The psychological cost)Tj -8.724 -1.401 TD -0.0033 Tc 0.0655 Tw [(of learning to kill in war and society)53.7(. )]TJ /TT2 1 Tf 15.426 0 TD -0.0041 Tc 0.0356 Tw [(New Y)103.1(ork: )-33(Little,)]TJ -15.426 -1.398 TD -0.0244 Tc 0 Tw (Brown.)Tj -1.2 -1.8 TD -0.0035 Tc 0.0867 Tw [(Haas, F)74.5(.)-0.5( \(2007\). S)17.5(tress in policing. )]TJ /TT7 1 Tf 14.469 0 TD -0.0038 Tc 0.0875 Tw [(T)57.4(raining Wheel, )]TJ /TT2 1 Tf 6.81 0 TD -0.0046 Tc 0 Tw (April-)Tj -20.079 -1.401 TD -0.019 Tc -0.0625 Tw (June 2007, 4-6.)Tj -1.2 -1.8 TD -0.0036 Tc 0.0249 Tw [(Heiman, M.F)77.4(. \(1975\). )14.3(The police suicide. )]TJ /TT7 1 Tf 16.77 0 TD -0.0039 Tc (Journal of Police)Tj -15.57 -1.401 TD -0.0036 Tc -0.005 Tw (Science and Administration, 3, )Tj /TT2 1 Tf 12.426 0 TD -0.0049 Tc 0 Tw (267-273.)Tj -13.626 -1.8 TD -0.0057 Tc -0.08 Tw [(Henry)66.3(,)-8.4( V)137.5(.E. )-17.8(\(2004\). )]TJ /TT7 1 Tf 7.74 0 TD -0.007 Tc -0.0625 Tw (Death work: Police, trauma, and the psy-)Tj -6.54 -1.398 TD -0.0034 Tc -0.0374 Tw (chology of survival. )Tj /TT2 1 Tf 7.986 0 TD -0.0037 Tc -0.037 Tw [(New )32.8(Y)103.5(ork: Oxford University Press.)]TJ -9.186 -1.8 TD -0.0033 Tc -0.0471 Tw (Higgins, R.L. & Leibowitz, R.Q. \(1999\). Reality negotiation)Tj 1.2 -1.401 TD -0.007 Tc -0.0621 Tw (and coping: The social construction of adaptive outcomes.)Tj T* -0.0024 Tc 0.1112 Tw (In C.R. Snyder \(Ed.\), )Tj /TT7 1 Tf 9.171 0 TD -0.0041 Tc 0.1125 Tw (Coping: The psychology of what)Tj -9.171 -1.398 TD -0.0088 Tc 0 Tw (works )Tj /TT2 1 Tf 2.529 0 TD -0.0085 Tc -0.06 Tw (\(pp. 20-49\).)Tj -3.729 -1.8 TD -0.0291 Tc -0.0621 Tw [(Honig, )52(A.L. & Roland, J.E. \(1998\). Shots fired: Of)15.9(ficer involved.)]TJ /TT7 1 Tf 1.2 -1.401 TD -0.0066 Tc -0.0616 Tw (The Police Chief, )Tj /TT2 1 Tf 6.924 0 TD -0.0625 Tw (October 1998, 65-70.)Tj -8.124 -1.8 TD -0.0072 Tc -0.0622 Tw [(Honig, )52.8(A.L. & Sultan, E. \(2004\). Reactions and resilience un-)]TJ 1.2 -1.401 TD -0.0034 Tc 0.1114 Tw (der fire: What an officer can expect. )Tj /TT7 1 Tf 15.366 0 TD -0.0039 Tc 0.1125 Tw (The Police Chief,)Tj /TT2 1 Tf -15.366 -1.398 TD -0.0186 Tc -0.0614 Tw [(December)38.4(, pp. 54-60.)]TJ -1.2 -1.8 TD -0.0034 Tc -0.0594 Tw (Horn, J.M. \(1991\). Critical incidents for law enforcement of-)Tj 1.2 -1.401 TD -0.0113 Tc -0.0625 Tw [(ficers. In J.T)69.7(. Reese, J.M. Horn & C. 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What value are cognitive defenses in critical)Tj 1.2 -1.398 TD -0.0031 Tc -0.0375 Tw (incident stress? In J. Reese, J. Horn & C. Dunning \(Eds.\),)Tj /TT7 1 Tf 0 -1.401 TD -0.0036 Tc 0.0338 Tw (Critical incidents in policing )Tj /TT2 1 Tf 11.805 0 TD -0.004 Tc 0.0356 Tw [(\(pp. 149-158\). )17.6(W)93.8(ashington)]TJ -11.805 -1.401 TD -0.0142 Tc -0.0625 Tw [(DC: US Government Printing Office.)]TJ 24.3 64.8 TD -0.0036 Tc -0.0563 Tw [(Jelinek, P)104.4(.)-0.5( \(2007\). )17.8(T)37.2(roops)68.4( ethics studied. )]TJ /TT7 1 Tf 16.221 0 TD -0.0043 Tc -0.0575 Tw (South Florida Sun-)Tj -15.021 -1.398 TD -0.0034 Tc 0 Tw (Sentinel, )Tj /TT2 1 Tf 3.681 0 TD -0.0024 Tc -0.01 Tw (May 5, p. 10A.)Tj -4.881 -1.8 TD -0.0041 Tc -0.0621 Tw [(Jones, E., )14.3(Thomas, )53.3(A., & Ironside, S. \(2007\). Shell shock: )50.3(A)9.1(n)]TJ 1.2 -1.401 TD -0.0031 Tc -0.0466 Tw [(outcome study of a First )18(W)94.8(orld )18(W)94.8(ar PIE unit. )]TJ /TT7 1 Tf 17.769 0 TD -0.0045 Tc 0 Tw (Psychologi-)Tj -17.769 -1.401 TD -0.0033 Tc -0.0617 Tw (cal Medicine, 37, )Tj /TT2 1 Tf 6.951 0 TD -0.0049 Tc 0 Tw (215-223.)Tj -8.151 -1.8 TD -0.0037 Tc -0.0003 Tw [(Kardiner)35.3(, A. )-50.7(\(1941\). )]TJ /TT7 1 Tf 8.43 0 TD -0.004 Tc 0.0509 Tw [(The traumatic neur)29(oses of war)107(. )]TJ /TT2 1 Tf 12.774 0 TD -0.0053 Tc 0 Tw [(W)92.6(ash-)]TJ -20.004 -1.398 TD -0.0039 Tc -0.0575 Tw (ington DC: National Research Council.)Tj -1.2 -1.8 TD -0.0036 Tc 0.0221 Tw (Karlsson, I. & Christianson, S.A. \(2003\). The phenomenol-)Tj 1.2 -1.401 TD -0.0032 Tc -0.0614 Tw (ogy of traumatic experiences in police work. )Tj /TT7 1 Tf 17.535 0 TD -0.0047 Tc -0.065 Tw (Policing: An)Tj -17.535 -1.401 TD -0.0039 Tc 0.0625 Tw (International Journal of Police Strategies and Manage-)Tj 0 -1.398 TD -0.0153 Tc -0.0625 Tw (ment, 26, )Tj /TT2 1 Tf 3.666 0 TD -0.0177 Tc 0 Tw (419-438.)Tj -4.866 -1.8 TD -0.0183 Tc -0.0622 Tw [(Kennedy)62.7(, D.B., Homant, R.J., & Hupp, R.T)71.7(. \(1998\). 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Death on duty: Police survivor trauma)]TJ /TT7 1 Tf 23.451 0 TD 0 Tc 0 Tw (.)Tj /TT2 1 Tf -22.251 -1.401 TD -0.0119 Tc -0.0621 Tw [(In J.M. )18.1(V)59.3(iolanti & D. Paton \(Eds.\), )]TJ /TT7 1 Tf 13.401 0 TD -0.013 Tc -0.0625 Tw (Police trauma: Psycho-)Tj -13.401 -1.398 TD -0.0121 Tc -0.062 Tw (logical aftermath of civilian combat )Tj /TT2 1 Tf 13.884 0 TD -0.0123 Tc -0.0625 Tw (\(pp. 139-158\). Spring-)Tj -13.884 -1.401 TD -0.011 Tc (field, IL: Charles C Thomas.)Tj 24.3 44.199 TD -0.0054 Tc [(V)62.8(iolanti, J.M. \(2000\). Scripting trauma: )15.6(The impact of patho-)]TJ 1.2 -1.398 TD -0.0034 Tc -0.0189 Tw [(genic intervention. In J. )14.6(V)64.8(iolanti, D. Paton & C. Dunning)]TJ 0 -1.401 TD 0.01 Tc 0 Tw (\(Eds.\), )Tj /TT7 1 Tf 3.12 0 TD 0.0088 Tc 0.125 Tw (Posttraumatic stress intervention: Challenges,)Tj -3.12 -1.401 TD -0.0036 Tc 0.1067 Tw (issues, and perspectives )Tj /TT2 1 Tf 10.065 0 TD (\(pp. 153-165\). Springfield, IL:)Tj -10.065 -1.398 TD -0.0043 Tc -0.0625 Tw (Charles C Thomas.)Tj -1.2 -1.8 TD -0.0051 Tc -0.0623 Tw [(W)92.7(ester)36.9(, S.R. & L)48.9(yubelsky)60.9(, J. \(2005\). Supporting the thin blue)]TJ 1.2 -1.401 TD -0.0033 Tc 0.0275 Tw (line: Gender-sensitive therapy with male police officers.)Tj /TT7 1 Tf T* -0.0037 Tc -0.0392 Tw (Professional Psychology: Research and Practice, 36, )Tj /TT2 1 Tf 21.18 0 TD -0.0065 Tc 0 Tw (51-)Tj -21.18 -1.398 TD -0.0625 Tc (58.)Tj -1.2 -1.8 TD -0.0073 Tc -0.0625 Tw [(W)57.5(illiams. M.B. \(1999\). Impact of duty-related death on of)16.7(fic-)]TJ 1.2 -1.401 TD -0.0035 Tc 0.1193 Tw (ers children: Concepts of death, trauma reactions, and)Tj T* 0.008 Tc 0.1249 Tw [(treatment. In J.M. )13.9(V)64.2(iolanti & D. Paton \(Eds.\), )]TJ /TT7 1 Tf 19.911 0 TD 0.007 Tc 0 Tw (Police)Tj -19.911 -1.398 TD -0.0038 Tc 0.0208 Tw (trauma: Psychological aftermath of civilian combat )Tj /TT2 1 Tf 20.931 0 TD -0.0047 Tc 0 Tw (\(pp.)Tj -20.931 -1.401 TD -0.0162 Tc -0.062 Tw (159-174\). Springfield, IL: Charles C Thomas.)Tj -1.2 -1.8 TD -0.0035 Tc 0.0249 Tw [(W)55.3(ilson, J.P)107.5(. \(1994\). )17.4(The historical evolution of PTSD diag-)]TJ 1.2 -1.401 TD -0.004 Tc 0.0175 Tw [(nostic criteria: From Freud to DSM-IV)125(.)-5.5( )]TJ /TT7 1 Tf 15.915 0 TD -0.0046 Tc 0.018 Tw [(Journal of T)49.4(rau-)]TJ -15.915 -1.398 TD -0.0095 Tc -0.0617 Tw (matic Stress, 7, )Tj /TT2 1 Tf 6.021 0 TD -0.0113 Tc 0 Tw (681-698.)Tj -7.221 -1.8 TD -0.0036 Tc -0.0558 Tw [(W)55.2(inerman, L. \(2006\). Coping through cognition. )]TJ /TT7 1 Tf 19.275 0 TD -0.0048 Tc -0.06 Tw (Monitor on)Tj -18.075 -1.401 TD -0.0128 Tc 0 Tw [(Psychology)53.2(, )]TJ /TT2 1 Tf 4.851 0 TD -0.0625 Tw (November 2006, 16-17.)Tj -6.051 -1.8 TD -0.0033 Tc 0.0561 Tw [(W)55.5(ittrup, R.G)116.7(. \(1986\). Police shooting )50.6(An opportunity for)]TJ 1.2 -1.401 TD -0.0045 Tc -0.0622 Tw [(growth or loss of self. In J.T)76.5(. Reese & H. Goldstein \(Eds.\),)]TJ /TT7 1 Tf 0 -1.398 TD -0.0034 Tc 0.125 Tw (Psychological Services for Law Enforcement )Tj /TT2 1 Tf 18.729 0 TD -0.0025 Tc (\(pp. 405-)Tj -18.729 -1.401 TD -0.0071 Tc -0.0627 Tw [(408\). )16.7(W)93.7(ashington DC: US Government Printing Of)16.9(fice.)]TJ -1.2 -1.8 TD -0.0058 Tc -0.0622 Tw (Zeling, M. \(1986\). Research needs in the study of post-shoot-)Tj 1.2 -1.401 TD -0.0111 Tc [(ing trauma. In J.T)72.9(. Reese & H.A. Goldstein \(Eds.\), )]TJ /TT7 1 Tf 19.359 0 TD -0.0133 Tc 0 Tw (Psycho-)Tj -19.359 -1.398 TD -0.0059 Tc -0.062 Tw [(logical services for law enfor)30.1(cement )]TJ /TT2 1 Tf 14.244 0 TD -0.0621 Tw [(\(pp. 409-410\). )18.4(W)97.9(ash-)]TJ -14.244 -1.401 TD -0.0204 Tc -0.0625 Tw (ington DC: USGPO.)Tj /TT7 1 Tf 9 0 0 9 396.75 293.01 Tm -0.0048 Tc 0.02 Tw [(Manuscript Received: November 4, 2007)]TJ 3.3333 -1.78 TD -0.0045 Tc -0.0089 Tw [(Revision Received: April 2, 2008)]TJ -1.1667 -1.7767 TD -0.0048 Tc -0.0167 Tw [(Manuscript Accepted: April 4, 2008)]TJ ET endstream endobj 145 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 147 0 obj << /Length 6701 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (27)Tj /TT3 1 Tf 7 0 0 7 124.41 726.66 Tm -0.0061 Tc 0.0226 Tw [(International Journal of Emergency Mental Health, Vol. 10, No. 1, pp. 27-38 2008 Chevron Publishing ISSN 1522-4821)]TJ /TT6 1 Tf 10 0 0 10 102.99 484.86 Tm -0.0041 Tc 0 Tw (Abstract: )Tj /TT7 1 Tf 3.951 0 TD -0.0037 Tc -0.0425 Tw (This review examines the current empirical research and literature on peer assistance programs,)Tj -3.951 -1.302 TD -0.0035 Tc 0.0611 Tw (peer support, and peer-facilitated interventions for police officers. A literature search was conducted to)Tj 0 -1.299 TD 0.0067 Tw (identify studies on police, peer support, and peer assistance programs. Studies were examined in terms of)Tj T* 0.0204 Tw (the following criteria: description of data collection methods, findings, study limitations, implications for)Tj 0 -1.302 TD -0.0153 Tw (police, workplace assistance, and peer support. Articles on peer support in the aftermath of the September)Tj 0 -1.299 TD -0.0051 Tc -0.0621 Tw [(1)74.9(1, 2001, W)81.9(orld T)51.9(rade Center r)27.9(escue and r)27.9(ecovery effor)-5.1(ts wer)30.9(e also r)27.9(eviewed. The r)30.9(esear)27.9(ch studies r)27.9(eviewed)]TJ T* -0.0035 Tc 0.0347 Tw (in this article do not evaluate peer program effectiveness from the perspective of those officers receiving)Tj 0 -1.302 TD 0.0198 Tw [(peer services. T)86.5(o)0.2( better serve this invaluable population, efforts must be made to incorporate their views.)]TJ 0 -1.299 TD 0.0105 Tc 0.125 Tw (Information is also needed on the effectiveness of peer assistance programs and peer-driven crisis)Tj T* -0.0038 Tc 0.0594 Tw [(inter)-6.8(vention models. Finally)53.2(, r)29.2(esear)32.2(ch is needed that specifically examines the effectiveness of pr)32.2(ograms)]TJ 0 -1.302 TD 0.004 Tc 0.125 Tw (that utilize trained peers in partnership with professional mental health practitioners. [International)Tj 0 -1.299 TD -0.0035 Tc 0.0688 Tw [(Journal of Emergency Mental Health, 2008, 10\(1\), pp. 27-38].)]TJ /TT1 1 Tf 9 0 0 9 114.24 314.01 Tm -0.0056 Tc 0 Tw (Key words: )Tj /TT7 1 Tf 5.1133 0 TD -0.0046 Tc 0.001 Tw (Emergency mental health, crisis intervention, peer assistance, peer support, police, program evaluation,)Tj 7.8033 -1.3333 TD -0.0049 Tc 0.0459 Tw (social support, trauma stress, training)Tj ET /GS1 gs 65.49 177.765 m 298.5 177.765 l S BT 9 0 0 9 65.49 159.99 Tm /GS2 gs 0.117 Tw [(Peggy Grauwiler)105.2(, LCSW)85.2(, Ph.D., is Dir)31.9(ector of Center Pr)35.2(ojects,)]TJ 0 -1.22 TD -0.0081 Tc -0.0615 Tw [(Center on V)61.9(iolence and Recover)-8.1(y)59.1(,)-3.8( New Y)85.2(ork University)55.2(,)-6.7( )-5.9(N)-6.7(Y)85.2(. Briana)]TJ 0 -1.2233 TD -0.0058 Tc -0.062 Tw [(Bar)37.5(ocas, Ph.D., is Dir)34.2(ector of Resear)37.5(ch and Linda G)124.2(.)0.6( Mills, LCSW)80.9(,)]TJ T* -0.0056 Tc -0.0622 Tw [(JD, Ph.D., is Senior V)67.7(ice Pr)37.7(ovost, Pr)34.4(ofessor of Social W)84.4(ork, Public)]TJ 0 -1.22 TD 0.0148 Tc 0.1252 Tw [(Policy and Law)68.1(, Executive Dir)38.1(ector)104.8(, Center on V)68.1(iolence and)]TJ 0 -1.2233 TD -0.0023 Tc 0.1272 Tw [(Recovery)51.5(,)-3.3( New Y)87.7(ork University)54.4(,)-6.3( N)-6.3(Y)87.7(. Cor)-9(r)43.5(espondence r)37.7(egar)37.7(ding)]TJ T* -0.0046 Tc -0.0545 Tw [(this ar)-7.9(ticle may be sent to: Peggy Grauwiler)108.7(, LCSW)82.1(, Ph.D., Center)]TJ 0 -1.22 TD -0.0082 Tc -0.0618 Tw [(on V)65.1(iolence and Recovery)52.3(,)-2.8( New Y)81.8(ork University)51.8(, 194 Mer)35.1(cer S)31.8(t)8.8(r)31.8(eet,)]TJ 0 -1.2233 TD -0.0133 Tc -0.0621 Tw [(4th Floor)100(, New Y)90(ork, NY 10012. E-mail: peggy)46.7(.grauwiler@nyu.edu.)]TJ /F1 1 Tf 14 0 0 14 92.01 645.36 Tm -0.0018 Tc 0.1382 Tw [(P)41.6(o)-1.1(lice P)23.9(eer Suppor)-27.5(t Pr)15.3(ograms:)34.6( Current Kno)11.1(wledg)-16.8(e and Practice)]TJ /TT2 1 Tf 12 0 0 12 149.64 548.64 Tm -0.0201 Tc -0.0625 Tw (Briana Barocas)Tj 10 0 0 10 117.39 536.01 Tm 0.0015 Tc -0.0224 Tw [(Center on )16.6(V)63.7(iolence and Recovery)]TJ 2.55 -1.2 TD -0.0044 Tc -0.0971 Tw [(New Y)102.8(ork )-35.3(University)]TJ 12 0 0 12 275.01 602.16 Tm -0.0351 Tc -0.0625 Tw (Peggy Grauwiler)Tj 10 0 0 10 245.4 589.5 Tm 0.0015 Tc -0.0225 Tw [(Center on )16.5(V)63.7(iolence and Recovery)]TJ 2.55 -1.2 TD -0.0044 Tc -0.0971 Tw [(New Y)102.8(ork )-35.3(University)]TJ 12 0 0 12 408 549.15 Tm -0.0337 Tc -0.0603 Tw [(Linda G)108.8(.)-1( Mills)]TJ 10 0 0 10 372.39 536.49 Tm 0.0015 Tc -0.0224 Tw [(Center on )16.6(V)63.7(iolence and Recovery)]TJ 2.55 -1.2 TD -0.0044 Tc -0.0971 Tw [(New Y)102.8(ork )-35.3(University)]TJ -31.389 -26.085 TD -0.0032 Tc 0.0243 Tw (First responders are relied upon daily across the nation)Tj -1.8 -1.398 TD -0.0035 Tc 0.0825 Tw (to respond to emergencies that threaten our lives, well-be-)Tj 0 -1.401 TD -0.0029 Tc -0.052 Tw [(ing, property)63.1(, peace, and security \(Howard & Rattien, 2004\).)]TJ T* -0.0034 Tc -0.0525 Tw (Along with firefighters, emergency medical technicians, and)Tj 0 -1.398 TD -0.0028 Tc 0.0764 Tw [(the military)63.2(, police of)15.2(ficers often play a critical role in the)]TJ 0 -1.401 TD -0.0037 Tc -0.0428 Tw (initial response to and management of both natural and man-)Tj 25.5 6.999 TD -0.0028 Tc 0.0194 Tw [(made disasters. )51.2(As key agents in any preparedness strategy)63.2(,)]TJ 0 -1.398 TD -0.0092 Tc -0.0625 Tw (the police will assume a variety of roles, and their experiences)Tj 0 -1.401 TD -0.0032 Tc -0.046 Tw (will differ depending on the tasks they engage in, their expo-)Tj T* -0.003 Tc -0.0006 Tw (sure to traumatic events, and the frequency with which they)Tj 0 -1.398 TD -0.0036 Tc 0.0795 Tw (can expect to be exposed to additional \(even more severe\))Tj 0 -1.401 TD -0.0034 Tc 0.0082 Tw (events. For example, disasters caused by mass violence and)Tj T* -0.0012 Tc 0.125 Tw (acts of terrorism are treated as crime scenes, and in such)Tj 0 -1.398 TD -0.0034 Tc -0.0207 Tw (cases, the police assume an additional and critical investiga-)Tj 0 -1.401 TD -0.0113 Tc -0.0623 Tw [(tory role \(Jackson, Baker)36.7(, Ridgely)57.7(, Bartis, & Linn, 2004\). Fur)18.7(-)]TJ T* 0.0141 Tc 0.125 Tw [(thermore, prolonged rescue, recovery)65.1(, and investigatory)]TJ 0 -1.398 TD -0.0033 Tc -0.0515 Tw (efforts may extend over weeks or months. This in turn forces)Tj 0 -1.401 TD -0.0035 Tc 0.0675 Tw (officers to endure uncertainty and ongoing threatscondi-)Tj T* -0.0029 Tc 0.0985 Tw (tions that may result in heightened anxiety and a sense of)Tj 0 -1.398 TD -0.0034 Tc 0.085 Tw (vulnerability among police and other first responders \(Na-)Tj ET endstream endobj 148 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 151 0 obj << /Length 8688 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0053 Tc 0.0896 Tw [(28 )]TJ /TT3 1 Tf 2.1938 0 TD -0.0054 Tc 0.0922 Tw (Grauwiler, Barocas, and Mills Police Peer Support Programs)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.006 Tc -0.0625 Tw (tional Child Traumatic Stress Network & National Center for)Tj 0 -1.398 TD -0.0335 Tc -0.06 Tw (PTSD, 2005\).)Tj 1.8 -2.001 TD -0.0034 Tc 0.1187 Tw (As first responders, police are engaged in a high-risk)Tj -1.8 -1.401 TD -0.0035 Tc 0.0669 Tw (occupation, and many will be exposed to multiple traumas)Tj 0 -1.398 TD -0.0159 Tc -0.0623 Tw (across their careers. Therefore, it is important to identify which)Tj 0 -1.401 TD -0.0034 Tc 0.0675 Tw (training and psychological interventions are most effective)Tj T* -0.0141 Tc -0.0625 Tw (to facilitate optimal work performance, including mechanisms)Tj 0 -1.398 TD -0.0034 Tc 0.0571 Tw [(that support ongoing rescue and recovery work, post-event)]TJ 0 -1.401 TD -0.0086 Tc -0.0625 Tw [(exposure adjustment, and long-term psychological health and)]TJ T* -0.0073 Tc (well-being \(National Institutes of Health [NIH], 2007\).)Tj 1.8 -1.998 TD -0.0036 Tc 0.0331 Tw (Police peer support programs have been utilized to ad-)Tj -1.8 -1.401 TD -0.0033 Tc 0.0236 Tw [(dress many of these needs; however)38.7(, the empirical research)]TJ T* -0.0183 Tc -0.0622 Tw (on such programs remains limited \(NIH, 2007\). This paper will)Tj 0 -1.398 TD -0.0034 Tc 0.0516 Tw (examine that gap, exploring the vital role that peer support)Tj 0 -1.401 TD -0.0031 Tc -0.0193 Tw (and peer assistance programs play immediately after critical)Tj T* -0.0033 Tc -0.0625 Tw (and other incidents, as well as the impact such programs may)Tj 0 -1.398 TD -0.0031 Tc -0.0236 Tw (have in mitigating officers ongoing day-to-day work stress.)Tj 0 -1.401 TD -0.0035 Tc 0.0255 Tw [(In particular)38.5(, studies were reviewed that seek to understand)]TJ T* -0.0037 Tc -0.0306 Tw (how peer support and peer programs help officers in manag-)Tj 0 -1.398 TD -0.0022 Tc 0.125 Tw (ing cumulative work-related stress reactions, and whether)Tj 0 -1.401 TD -0.0035 Tc -0.0611 Tw (such programs are an effective option to protect against post-)Tj T* -0.0038 Tc 0.013 Tw (trauma adjustment disorders \(including posttraumatic stress)Tj 0 -1.398 TD 0 Tw (disorder\).)Tj 1.8 -2.001 TD -0.0034 Tc 0.02 Tw (Some of the literature reviewed in this article was con-)Tj -1.8 -1.401 TD -0.0035 Tc -0.0382 Tw (ducted after September 11, 2001, because this event resulted)Tj 0 -1.398 TD 0.0382 Tw [(in the large-scale mobilization of several existing peer pro-)]TJ 0 -1.401 TD -0.0037 Tc -0.061 Tw (grams. These programs were part of an ongoing \(more than 2)Tj T* -0.0032 Tc 0.0082 Tw [(year\) lar)14.8(ge-scale peer intervention ef)17.8(fort for New )29.9(Y)104(ork City)]TJ 0 -1.398 TD -0.0034 Tc -0.0188 Tw [(Police Of)17.6(ficers and other first responders. )14.7(T)73.4(o)-0.3( date, this post-)]TJ 0 -1.401 TD -0.0042 Tc -0.0622 Tw (9/11 literature is the most systematic effort at an examination)Tj T* -0.0031 Tc 0.0029 Tw (of peer interventions for police that currently exists.)Tj /F1 1 Tf 11 0 0 11 142.89 252 Tm 0.0135 Tc 0 Tw [(O)44.2(V)5.1(E)5.1(R)40.8(VIEW)]TJ /TT2 1 Tf 10 0 0 10 72 228.66 Tm -0.0111 Tc -0.0621 Tw (Police work has evolved into a high-profile, professional,)Tj -1.8 -1.401 TD -0.0034 Tc 0.1005 Tw (round the clock, public service; the nature of policing has)Tj T* -0.0245 Tw (expanded to include a diverse range of activities that require)Tj 0 -1.398 TD -0.0036 Tc -0.0584 Tw (a complex set of skills from officers. From maintaining com-)Tj 0 -1.401 TD -0.003 Tc 0.0618 Tw [(munity relations to ensuring public safety via law enforce-)]TJ T* 0.0081 Tc 0.125 Tw (ment, counterterrorism activities, and national homeland)Tj 0 -1.398 TD -0.0129 Tc -0.062 Tw [(security)62.1(, of)17.1(ficers)71.1( ever expanding array of responsibilities now)]TJ 0 -1.401 TD -0.0031 Tc 0.125 Tw (precipitate more severe sources of stress than ever before)Tj T* -0.0095 Tc -0.0624 Tw [(\(Raymond, Hickman, Miller)35.5(, & )14.6(W)94.3(ong, 2005\). In addition, po-)]TJ 0 -1.398 TD -0.0106 Tc -0.0625 Tw (lice officers are vested with the public trust and, when needed,)Tj 0 -1.401 TD -0.0032 Tc -0.054 Tw (the authority to use force against the public to maintain order)Tj T* -0.0037 Tc -0.0625 Tw [(and enforce societal laws \(Raymond et al., 2005\). )50.3(As a result,)]TJ 25.5 64.8 TD -0.0034 Tc 0.015 Tw (police are under pressure to remain lawful, often in danger-)Tj 0 -1.398 TD -0.0038 Tc 0.0284 Tw (ous and unprecedented circumstances, while also enforcing)Tj 0 -1.401 TD -0.0108 Tc -0.0617 Tw (civil obedience \(Paoline, 2003\).)Tj 1.8 -2.001 TD -0.0033 Tc -0.0105 Tw (It has been established in the research literature that the)Tj -1.8 -1.398 TD -0.0036 Tc 0.0894 Tw (nature of police work, coupled with exposure to traumatic)Tj 0 -1.401 TD 0.0671 Tw (events, can have negative consequences for individuals re-)Tj T* -0.0034 Tc 0.0728 Tw (sulting in posttraumatic adjustment issues \(Reyes & Elhai,)Tj 0 -1.398 TD 0.0257 Tw [(2004\). )50.6(Additionally)62.6(, the cumulative ef)17.6(fects of this high-risk)]TJ 0 -1.401 TD -0.0051 Tc -0.0623 Tw (occupation have been shown to affect police families. In fact,)Tj T* -0.0033 Tc -0.0383 Tw (the unusually high suicide and divorce rates of first respond-)Tj 0 -1.398 TD -0.0037 Tc -0.0465 Tw (ers in generaland police in particularraise questions and)Tj 0 -1.401 TD -0.0036 Tc 0.0244 Tw [(concerns about the long-term impact of this work on police)]TJ T* -0.0289 Tc -0.0625 Tw (officers and their family members \(Kirschman, 1997; Loo, 1999,)Tj 0 -1.398 TD -0.0113 Tc -0.0812 Tw [(2003; W)53.5(itt, )-18.5(2005; )-6(W)92.6(oody)66.7(, )-19.4(2006\).)]TJ /F1 1 Tf 11 0 0 11 309 501.99 Tm -0.0053 Tc 0.0549 Tw [(P)42.6(olice P)27.4(eer Assistance Pr)13.8(ograms)]TJ /TT2 1 Tf 10 0 0 10 327 478.65 Tm -0.0039 Tc -0.039 Tw (Police department-based peer assistance programs were)Tj -1.8 -1.401 TD -0.0034 Tc -0.0245 Tw (first put into practice after a police-involved shooting in Los)Tj 0 -1.398 TD -0.0036 Tc 0.0394 Tw (Angeles in 1981. The specific aim was to address work-re-)Tj 0 -1.401 TD -0.0038 Tc 0.11 Tw (lated stress among officers \(Robinson & Murdoch, 2003\).)Tj T* -0.0036 Tc (Since then the use of peer programs within police depart-)Tj 0 -1.398 TD 0.03 Tw (ments has grown. The size, location, sponsorship, and rela-)Tj 0 -1.401 TD -0.0033 Tc 0.1219 Tw (tionship to the department vary from location to location.)Tj T* -0.0035 Tc -0.0512 Tw [(However)35.5(, these programs all share the belief that peers are in)]TJ 0 -1.398 TD -0.0017 Tc 0.125 Tw (the best position to help other peers to recognize and ac-)Tj 0 -1.401 TD -0.0036 Tc 0.0243 Tw (knowledge work-related stress and to facilitate an interven-)Tj T* -0.0037 Tc 0.1206 Tw (tion before the problem becomes life threatening \(Finn &)Tj 0 -1.398 TD -0.0092 Tc -0.062 Tw [(T)70.6(omz, 1997; Robinson & Murdoch, 2003\).)]TJ 1.8 -2.001 TD 0.0008 Tc 0.1249 Tw [(T)71.6(o)-1.2(day)60.8(, police peer assistance programs provide first-)]TJ -1.8 -1.401 TD -0.0034 Tc 0.0519 Tw (line assistance and basic crisis intervention to fellow offic-)Tj 0 -1.398 TD 0.0258 Tc 0.125 Tw (ers, relying on carefully selected, highly trained para-)Tj 0 -1.401 TD -0.0038 Tc 0.0479 Tw (professionals who are drawn from within the organizations)Tj T* -0.0037 Tc 0.1 Tw (they serve \(Robinson & Murdoch, 2003\). These programs)Tj 0 -1.398 TD -0.0036 Tc 0.1206 Tw (offer immediate and ongoing peer support after a disaster)Tj 0 -1.401 TD -0.0031 Tc 0.0984 Tw (that, if left unaddressed, may lead to substance abuse, de-)Tj T* 0.0021 Tc 0.125 Tw (pression, illness, or more serious psychological disorders)Tj 0 -1.398 TD -0.0098 Tc -0.062 Tw (\(Chamberlin, 2000; Robinson & Murdoch, 2003\).)Tj 1.8 -2.001 TD -0.0084 Tc -0.0625 Tw (Law enforcement assistance programs have also evolved)Tj -1.8 -1.401 TD -0.0037 Tc 0.0587 Tw (to provide services geared toward the management of gen-)Tj 0 -1.398 TD -0.0035 Tc 0.12 Tw (eral occupational stress \(unique to police work\). Even so,)Tj 0 -1.401 TD -0.0136 Tc -0.0621 Tw (although assistance programs have been implemented in some)Tj T* -0.0036 Tc 0.0206 Tw (law enforcement agencies across the United States, the em-)Tj 0 -1.398 TD -0.0037 Tc -0.0385 Tw (pirical research on intervention strategies and program mod-)Tj 0 -1.401 TD -0.0035 Tc -0.0257 Tw (els is extremely limited and somewhat inconclusive \(Finn &)Tj T* -0.0034 Tc -0.0133 Tw [(T)73.4(omz, 1998\). Despite this gap in the literature, however)35.6(, so-)]TJ ET endstream endobj 152 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 154 0 obj << /Length 9152 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (29)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0035 Tc -0.0386 Tw (cial support is considered one vital occupational characteris-)Tj 0 -1.398 TD -0.0031 Tc 0.1 Tw (tic of police culture that plays a pivotal role in workplace)Tj 0 -1.401 TD -0.0038 Tc -0.0106 Tw (stress managements \(Stephens & Long, 2000\). It has indeed)Tj T* -0.0032 Tc 0.0069 Tw (been found to prevent negative long-term physical and psy-)Tj 0 -1.398 TD -0.0038 Tc 0.0059 Tw (chological health consequences following a traumatic event)Tj 0 -1.401 TD -0.0046 Tc -0.0621 Tw [(\(Boscarino, 1995; Joseph, )31.4(Y)111.6(ule, )16.4(W)54.2(illiams, & )52.4(Andrews, 1993;)]TJ T* 0.0078 Tc 0.125 Tw [(Norris & Kaniasty)61.8(, 1996; Solomon & Mikulincer)37.8(, 1990;)]TJ 0 -1.398 TD -0.004 Tc -0.0566 Tw (Stephens & Long, 2000\).)Tj /TT7 1 Tf 11 0 0 11 66 591.36 Tm 0.0206 Tc 0.1249 Tw [(Significance of W)88.8(orkplace Social Support)]TJ /TT2 1 Tf 10 0 0 10 84 571.65 Tm -0.0035 Tc -0.0625 Tw (Social support in the workplace is significant in alleviat-)Tj -1.8 -1.401 TD -0.007 Tc (ing stress for all workers, but it may be particularly so for first)Tj 0 -1.398 TD -0.0035 Tc 0.0785 Tw (responders, including police. Social support can buffer the)Tj 0 -1.401 TD -0.0038 Tc -0.0625 Tw (stress of work demands and help alleviate the impact of work)Tj T* -0.0036 Tc -0.0278 Tw [(exhaustion \(House, 1981\). )17.5(V)64.6(iewed as an interpersonal trans-)]TJ 0 -1.398 TD -0.0034 Tc 0.0965 Tw (action, social support may include: emotional support \(es-)Tj 0 -1.401 TD -0.0053 Tc -0.0621 Tw (teem, affection, and trust\); appraisal support \(affirmation and)Tj T* -0.0103 Tc -0.062 Tw [(feedback\); instrumental support \(money)58.7(, labor)40.7(, and time\); and)]TJ 0 -1.398 TD -0.0036 Tc 0.1 Tw (informational support \(advice, suggestions, and directives;)Tj 0 -1.401 TD -0.0034 Tc -0.0321 Tw [(House, 1981\). However)35.6(, to fully understand the significance)]TJ T* -0.0035 Tc -0.0623 Tw (of social support in the workplace, it is also important to look)Tj 0 -1.398 TD 0.04 Tw (at received support \(actual support received\) and perceived)Tj 0 -1.401 TD 0.0059 Tc 0.125 Tw (support \(perceptions about support available\), as well as)Tj T* -0.0037 Tc -0.0492 Tw (support provided through formal \(professional services\) ver-)Tj 0 -1.398 TD -0.0035 Tc 0.0092 Tw [(sus informal \(family)59.5(, friends\) sources \(Armeli, Eisenber)17.5(ger)35.5(,)]TJ 0 -1.401 TD -0.0151 Tc -0.0625 Tw [(Fasolo, & L)50.9(ynch, 1998; Joseph et al., 1993; Norris & Kaniasty)59.9(,)]TJ T* -0.0032 Tc -0.059 Tw [(1996\). Finally)62.8(, it is also important to consider who within the)]TJ 0 -1.398 TD -0.0037 Tc 0.1 Tw (workplace provides social support and what this means to)Tj 0 -1.401 TD -0.0035 Tc -0.0081 Tw [(the workers \(Gerstner & Day)62.5(, 1997; Schriesheim, Castro, &)]TJ T* -0.0247 Tc -0.0592 Tw [(Cogliser)41.3(, 1999\).)]TJ 1.8 -1.998 TD -0.0035 Tc 0.0165 Tw (Although workplace social support may be effective in)Tj -1.8 -1.401 TD -0.0587 Tw (reducing stress \(House, 1981\), critical questions remain as to)Tj T* 0.1187 Tw (how and whether police will access such support systems)Tj 0 -1.398 TD -0.0083 Tc -0.0625 Tw (within the workplace. This is a very complex issue, with roots)Tj 0 -1.401 TD -0.0063 Tc (in departmental expectations of police as well as the nature of)Tj T* (police work. Police are expected to address horrendous crime)Tj 0 -1.398 TD -0.0034 Tc 0.085 Tw (scenes but are trained to dissociate from )Tj /TT7 1 Tf 16.755 0 TD -0.0064 Tc 0 Tw (any)Tj /TT2 1 Tf 1.431 0 TD -0.0044 Tc 0.0875 Tw [( normal emo-)]TJ -18.186 -1.401 TD -0.0083 Tc -0.0624 Tw [(tional reactions to the work \(Levenson & Dwyer)36.7(, 2003\). )30.8(Y)101.9(et it)]TJ T* -0.0025 Tc 0.0675 Tw (may well be that )Tj /TT7 1 Tf 7.116 0 TD -0.0037 Tc (shutting off )Tj /TT2 1 Tf 4.869 0 TD -0.0036 Tc 0.069 Tw (is not possible over time and)Tj -11.985 -1.398 TD -0.0367 Tw (that the denial of emotional reactions has the most detrimen-)Tj 0 -1.401 TD -0.0075 Tc -0.0621 Tw [(tal ef)16.5(fect on an of)10.5(ficer)-37.5()55.5(s)-0.2( well-being. )55.6(An examination of police)]TJ T* -0.0035 Tc 0.0615 Tw (acceptance and use of workplace employee assistance pro-)Tj 0 -1.398 TD 0.0048 Tc 0.125 Tw (grams \(EAPs\) found that although a majority of officers)Tj 0 -1.401 TD -0.0036 Tc -0.0622 Tw (\(70.7%\) were aware of the available EAP services, only 22%)Tj T* -0.0061 Tw (had ever utilized these services for themselves \(Asen & Co-)Tj 0 -1.398 TD 0.0094 Tw [(lon, 1995\). However)38.5(, 54.9% of the participants knew of an-)]TJ 25.5 64.698 TD -0.0037 Tc 0.0138 Tw (other police officer who had used EAP services, suggesting)Tj 0 -1.398 TD -0.0033 Tc -0.01 Tw (that participation is not confidential or that officers utilizing)Tj 0 -1.401 TD -0.0037 Tc -0.0621 Tw (EAP services discuss these experiences with their colleagues)Tj T* -0.0079 Tc -0.0617 Tw (\(Asen & Colon, 1995\).)Tj /TT7 1 Tf 11 0 0 11 321 647.34 Tm 0.0117 Tc 0.125 Tw [(Police Cultur)36.2(e and Help Seeking)]TJ /TT2 1 Tf 10 0 0 10 339 627.66 Tm -0.0035 Tc -0.051 Tw (Policing has been described as more than a line of work;)Tj -1.8 -1.401 TD -0.0031 Tc 0.0508 Tw (the job is viewed rather as a way of life with a worthwhile)Tj T* -0.0037 Tc -0.0449 Tw [(purpose \(Reiner)35.3(, 1992\). )14.4(Thus, strong professional identifica-)]TJ 0 -1.398 TD -0.0028 Tc 0.0295 Tw (tion is a key element in police culture, characterized by the)Tj 0 -1.401 TD -0.0034 Tc 0.1015 Tw (shared sense of mission that officers hold in regard to the)Tj T* -0.003 Tc 0.0325 Tw (work they do and a responsibility for the well-being of one)Tj 0 -1.398 TD -0.0044 Tc -0.0622 Tw [(another \(Murray)61.6(, 2005; Reiner)40.6(, 1992\). However)34.6(, police work)]TJ 0 -1.401 TD -0.0032 Tc -0.0569 Tw [(also occurs within the context of a paramilitary organization.)]TJ T* -0.0206 Tw (This paramilitary context limits autonomy and is not condu-)Tj 0 -1.398 TD -0.0037 Tc 0.0883 Tw (cive to meaningful interpersonal relationships between su-)Tj 0 -1.401 TD -0.0039 Tc 0.0043 Tw [(pervisors and subordinates \(V)56.1(iolanti & )50.1(Aron, 1994\). Renck,)]TJ T* -0.0035 Tc 0.0855 Tw [(W)94.4(eisth, and Skarb \(2002\), as well, have shown that the)]TJ 0 -1.398 TD -0.0032 Tc 0.1243 Tw (organizational setting plays a significant role in traumatic)Tj 0 -1.401 TD -0.0034 Tc 0.0175 Tw (stress reactions and that other organizational issues are per-)Tj T* -0.0036 Tc 0.0033 Tw (tinent to understanding and managing work-related psycho-)Tj 0 -1.398 TD 0.0446 Tc 0.125 Tw (logical trauma. Their work further suggests that the)Tj 0 -1.401 TD -0.0044 Tc -0.0625 Tw (organizational environment can define the framework within)Tj T* -0.0031 Tc -0.029 Tw [(which trauma and recovery may occur)50.9(.)]TJ 1.8 -1.998 TD -0.0034 Tc 0.1042 Tw (Although many scholars emphasize the uniquely sup-)Tj -1.8 -1.401 TD -0.0031 Tc -0.0206 Tw (portive role that camaraderie may play among first respond-)Tj T* -0.003 Tc 0.0719 Tw (ers, they also mention some potentially negative effects of)Tj 0 -1.398 TD -0.0054 Tc -0.0625 Tw (this form of bond \(Paton, 1997\). Officer solidarity can lead to)Tj 0 -1.401 TD -0.0036 Tc 0.0176 Tw [(an us against them mentality)59.4(. )17.2(This can be a double-edged)]TJ T* -0.0038 Tc -0.0464 Tw (sword that weakens existing emotional attachment to outsid-)Tj 0 -1.398 TD -0.0036 Tc 0.0963 Tw [(ers, including spouses and other family members \(W)77.4(oody)59.4(,)]TJ 0 -1.401 TD -0.0046 Tc -0.0625 Tw (2005\). In fact, one study showed that talking things over with)Tj T* -0.0034 Tc 0.05 Tw (a coworker was the most frequent coping strategy reported)Tj 0 -1.398 TD 0.0124 Tw [(while on duty)62.6(. )29.5(Y)103.8(et keeping things to oneself was the coping)]TJ 0 -1.401 TD -0.0029 Tc 0.0325 Tw (strategy more frequently used while off duty \(Alexander &)Tj T* -0.013 Tc -0.062 Tw [(W)96.8(alker)35(, 1994\). Greenstone \(2000\) found that law enforcement)]TJ 0 -1.398 TD -0.0033 Tc 0.1119 Tw (officersregardless of the intensity of their work and the)Tj 0 -1.401 TD 0.0675 Tw (cumulative effect of related stressorsare generally reluc-)Tj T* -0.0029 Tc 0.12 Tw (tant to seek any assistance. They are furthermore particu-)Tj 0 -1.398 TD -0.0058 Tc -0.0621 Tw (larly resistant to professional mental health intervention. One)Tj 0 -1.401 TD -0.0034 Tc -0.0367 Tw (explanation for this resistance has been that officers begin to)Tj T* -0.0028 Tc 0.0333 Tw (feel that only other officers can fully appreciate their situa-)Tj 0 -1.398 TD -0.0037 Tc -0.006 Tw [(tions and of)17.3(fer helpful insights \(W)77.3(oody)59.3(, 2005\).)]TJ 1.8 -2.001 TD -0.0028 Tc 0.125 Tw (Although there is a significant body of literature that)Tj -1.8 -1.401 TD -0.0034 Tc 0.0509 Tw (looks at police officer characteristics, culture, work-related)Tj 0 -1.398 TD -0.0035 Tc -0.035 Tw (stress, coping, and burnout, there remain few controlled out-)Tj ET endstream endobj 155 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 157 0 obj << /Length 9884 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0053 Tc 0.0896 Tw [(30 )]TJ /TT3 1 Tf 2.1938 0 TD -0.0054 Tc 0.0922 Tw (Grauwiler, Barocas, and Mills Police Peer Support Programs)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0022 Tc 0.125 Tw (come studies of disaster mental health services for police)Tj 0 -1.398 TD -0.0035 Tc -0.0381 Tw (and other first responders \(Institute of Medicine, 2003; NIH,)Tj 0 -1.401 TD -0.0049 Tc -0.0625 Tw [(2007; National Institute of Mental Health, 2002\).)]TJ /TT7 1 Tf 11 0 0 11 54 661.35 Tm 0.0143 Tc 0.1262 Tw [(Per)30.7(ceptions of Help SeekingS)27.9(tigma)]TJ /TT2 1 Tf 10 0 0 10 72 641.64 Tm -0.0033 Tc -0.0127 Tw [(T)37.5(raditionally)62.7(, police of)14.7(ficers have been known to be re-)]TJ -1.8 -1.398 TD -0.0036 Tc 0.0061 Tw (luctant to seek formal help or assistance in managing work-)Tj 0 -1.401 TD -0.056 Tw (related stressparticularly from mental health professionals)Tj T* -0.0101 Tc -0.0625 Tw [(\(Paton, 1997; )16.9(W)93.7(oody)58.9(, 2005\). Miller \(1995\) found that seeking)]TJ 0 -1.398 TD -0.0028 Tc 0.125 Tw (assistance was believed to be a sign of cowardice and an)Tj 0 -1.401 TD -0.0059 Tc -0.0625 Tw (admission of incompetence among law enforcement officers.)Tj T* -0.003 Tc 0.0805 Tw (As a result, police officers are frequently reluctant to seek)Tj 0 -1.398 TD -0.0033 Tc 0.0716 Tw (department-based assistance, fearing that any indication of)Tj 0 -1.401 TD -0.0031 Tc -0.0206 Tw (weakness may result in threats to their careers. For instance,)Tj T* -0.0035 Tc 0.0166 Tw [(a police of)17.5(ficer)-39.5()56.5(s)0( disclosing or evidencing high stress in the)]TJ 0 -1.398 TD -0.0032 Tc 0.0105 Tw (workplace may risk confiscation of his firearm if that stress)Tj 0 -1.401 TD -0.0036 Tc -0.0137 Tw (reaction is viewed as threatening job performance. The con-)Tj T* -0.0037 Tc 0.0072 Tw (fiscation of firearms would result in an assignment to desk)Tj 0 -1.398 TD -0.0048 Tc -0.0621 Tw (duty and the accompanying humiliation associated with this)Tj 0 -1.401 TD -0.0052 Tc -0.0624 Tw [(intervention \(Levenson & Dwyer)39.8(, 2003\).)]TJ 1.8 -2.001 TD -0.0035 Tc 0.0538 Tw (Although such an intervention is critical to protect de-)Tj -1.8 -1.398 TD -0.0029 Tc -0.052 Tw [(partment liability)63.1(, it may result in a number of other negative)]TJ 0 -1.401 TD -0.0103 Tc -0.0625 Tw (consequences, such as censure, stigmatization, ridicule, alien-)Tj T* -0.0033 Tc -0.0568 Tw (ation, and possibly limited career advancement for an officer)Tj 0 -1.398 TD -0.0031 Tc -0.0033 Tw [(\(Levenson & Dwyer)35.9(, 2003; )14.9(W)97.7(oody)59.9(, 2005\). It may also have)]TJ 0 -1.401 TD 0.0325 Tw (financial implications, as officers assigned to desk duty are)Tj T* -0.0034 Tc -0.0193 Tw (not permitted to volunteer for or collect overtime.)Tj /F1 1 Tf 11 0 0 11 148.14 309 Tm 0.0198 Tc 0 Tw (METHOD)Tj /TT2 1 Tf 10 0 0 10 72 285.66 Tm -0.0033 Tc -0.0169 Tw (A literature search was conducted to identify studies on)Tj -1.8 -1.401 TD -0.0003 Tc 0.125 Tw [(peer support and peer assistance programs for police and)]TJ T* -0.0034 Tc 0.0272 Tw (other first responders. The search was further refined to fo-)Tj 0 -1.398 TD -0.0035 Tc 0.0245 Tw (cus on the effectiveness of peer support and assistance pro-)Tj 0 -1.401 TD 0.1169 Tw (grams for police. This focus also revealed some literature)Tj T* -0.0034 Tc 0.0917 Tw (related to police and other first responder peer support ef-)Tj 0 -1.398 TD -0.0086 Tc -0.0617 Tw (forts made immediately following the September 11)Tj 5.8 0 0 5.8 254.94 204.99 Tm 0 Tc 0 Tw ( )Tj 10 0 0 10 256.05 201.66 Tm -0.0097 Tc -0.065 Tw (attack on)Tj -20.205 -1.401 TD -0.0035 Tc -0.0129 Tw [(the )17.6(W)94.3(orld )17.6(T)37.3(rade Center in New )32.6(Y)103.7(ork City \(peer support was)]TJ T* -0.0031 Tc 0.0961 Tw (offered for the duration of the rescue and recovery efforts)Tj 0 -1.398 TD -0.0029 Tc 0.0013 Tw (and continued for approximately 2 years beyond the event\).)Tj 0 -1.401 TD -0.0033 Tc 0.0587 Tw (The articles selected for retrieval included those that refer-)Tj T* -0.0031 Tc 0.0173 Tw (enced, either in the title or abstract, police, first responders,)Tj 0 -1.398 TD -0.0034 Tc 0.04 Tw (crisis intervention, workplace assistance, or peer support.)Tj 1.8 -2.001 TD 0.0051 Tc 0.125 Tw (Key words included)Tj /TT1 1 Tf 8.4 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.384 0 TD 0.0054 Tc 0.125 Tw (police, law enforcement, police)Tj -10.584 -1.401 TD 0.0002 Tc (stress, workplace assistance, peer support, social support,)Tj 0 -1.398 TD -0.0034 Tc -0.016 Tw (critical incidents, interventions, utilization, program evalua-)Tj 25.5 65.298 TD 0.0916 Tw (tion, program effectiveness, police characteristics, and po-)Tj 0 -1.398 TD 0.0963 Tw (lice culture. For articles pertaining to 9/11 police involve-)Tj 0 -1.401 TD -0.0056 Tc -0.0625 Tw (ment, search criteria included September 11, 2001, WTC and)Tj T* 0.0034 Tc 0.125 Tw (health, and WTC and police.)Tj /TT7 1 Tf 12.096 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.384 0 TD 0.004 Tc 0.125 Tw (The databases searched in-)Tj -12.48 -1.398 TD -0.0034 Tc 0.0778 Tw [(clude: PyschInfo, PyschLit, ProQuest, Social Services )50.9(Ab-)]TJ 0 -1.401 TD -0.0037 Tc 0.0544 Tw [(stracts, Social )17.5(W)94.2(ork )50.5(Abstracts, and Sociological )53.5(Abstracts.)]TJ 1.8 -2.001 TD -0.0034 Tc 0.0125 Tw (The reference lists of selected studies and articles were)Tj -1.8 -1.398 TD -0.0031 Tc 0.0187 Tw (screened for other relevant studies. Only articles specific to)Tj 0 -1.401 TD -0.0034 Tc 0.0149 Tw [(police were considered for this review)62.6(. Selected articles ap-)]TJ T* -0.0036 Tc -0.007 Tw (peared in the following publications: )Tj /TT7 1 Tf 14.799 0 TD -0.0043 Tc -0.0075 Tw (The American Journal)Tj -14.799 -1.398 TD -0.0037 Tc -0.0553 Tw (of Psychiatry)Tj /TT2 1 Tf 5.199 0 TD 0.001 Tc 0 Tw (, )Tj /TT7 1 Tf 0.441 0 TD -0.004 Tc -0.0574 Tw [(Brief T)53(r)34.2(eatment and Crisis Intervention)]TJ /TT2 1 Tf 15.42 0 TD 0.001 Tc 0 Tw (, )Tj /TT7 1 Tf 0.441 0 TD -0.0047 Tc (Criti-)Tj -21.501 -1.401 TD 0.02 Tw (cal Care)Tj /TT2 1 Tf 3.459 0 TD 0 Tc 0 Tw (, )Tj /TT7 1 Tf 0.525 0 TD -0.0042 Tc 0.0234 Tw (FBI Law Enforcement Bulletin)Tj /TT2 1 Tf 12.261 0 TD 0 Tc 0 Tw (, )Tj /TT7 1 Tf 0.525 0 TD -0.0042 Tc 0.025 Tw (The Forensic Ex-)Tj -16.77 -1.401 TD -0.0056 Tc 0 Tw (aminer)Tj /TT2 1 Tf 2.805 0 TD 0.001 Tc (, )Tj /TT7 1 Tf 0.486 0 TD -0.0041 Tc -0.017 Tw [(International Journal of Emer)31.9(gency Mental Health)]TJ /TT2 1 Tf 20.16 0 TD 0 Tc 0 Tw (,)Tj /TT7 1 Tf -23.451 -1.398 TD -0.004 Tc -0.0263 Tw (Journal of Emergency Medical Services)Tj /TT2 1 Tf 15.744 0 TD 0.001 Tc 0 Tw (, )Tj /TT7 1 Tf 0.471 0 TD -0.0042 Tc -0.0275 Tw (Journal of Organi-)Tj -16.215 -1.401 TD -0.0043 Tc 0.035 Tw (zational Behavior)Tj /TT2 1 Tf 7.104 0 TD 0 Tc 0 Tw (, )Tj /TT7 1 Tf 0.54 0 TD -0.004 Tc 0.0384 Tw [(Morbidity and Mortality W)86(eekly Report)]TJ /TT2 1 Tf 15.807 0 TD 0 Tc 0 Tw (,)Tj /TT7 1 Tf -23.451 -1.401 TD -0.0032 Tc 0.125 Tw (Occupational Medicine)Tj /TT2 1 Tf 9.474 0 TD -0.0016 Tc (, and )Tj /TT7 1 Tf 2.442 0 TD -0.0037 Tc [(The New Y)86.3(ork T)50.3(imes)]TJ /TT2 1 Tf 8.478 0 TD -0.0017 Tc 0.0727 Tw [(.)-6.7( All )-52.3(ar)19.3(-)]TJ -20.394 -1.398 TD -0.0038 Tc -0.0278 Tw (ticles used were published between 1997 and 2007.)Tj 1.8 -2.001 TD -0.0034 Tc -0.04 Tw (Peer support is a model of intervention that is utilized in)Tj -1.8 -1.401 TD 0.0105 Tc 0.125 Tw (numerous and varied settings \(i.e., in 12-step programs,)Tj 0 -1.398 TD 0.0069 Tc (school-based suicide prevention programs, and those for)Tj 0 -1.401 TD -0.0128 Tc -0.0619 Tw [(railroad workers\). However)38.2(, the literature lacks continuity and)]TJ T* -0.0035 Tc 0.0305 Tw (focus in regard to police peer assistance programs and peer)Tj 0 -1.398 TD -0.0032 Tc 0.1044 Tw (support research. In fact, most studies on police generally)Tj 0 -1.401 TD -0.0033 Tc 0.0355 Tw (tend to look at the characteristics of police officers and po-)Tj T* 0.0493 Tw (lice culture, whereas few specifically address outcomes re-)Tj 0 -1.398 TD -0.0035 Tc 0.024 Tw (lated to intervention effectiveness with police.)Tj 1.8 -2.001 TD -0.0032 Tc 0.1119 Tw [(T)73.6(o)0( date, only three published studies were found that)]TJ -1.8 -1.401 TD -0.0033 Tc 0.0293 Tw (focus exclusively on the issue of workplace peer assistance)Tj 0 -1.398 TD -0.0035 Tc 0.0995 Tw [(and support for police. For the purposes of this paper)35.5(, the)]TJ 0 -1.401 TD -0.0052 Tc -0.0622 Tw (studies were examined in terms of the following four criteria:)Tj T* -0.0034 Tc -0.0093 Tw (description of data collection methods; findings; study limi-)Tj 0 -1.398 TD -0.0027 Tc 0.125 Tw (tations; and implications for police, workplace assistance,)Tj 0 -1.401 TD -0.0034 Tc 0.0661 Tw [(and peer support. )50.6(Although not an empirical study)62.6(, one re-)]TJ T* 0.1039 Tw (port was identified that reviewed the literature on law en-)Tj 0 -1.398 TD -0.0037 Tc -0.0428 Tw (forcement stress and stress programs including peer support.)Tj 0 -1.401 TD -0.0036 Tc -0.0244 Tw (This report provides an examination of the nature of support)Tj T* -0.0033 Tc 0.0266 Tw [(programs and is included in this review)62.7(. Finally)59.7(, several ar)17.7(-)]TJ 0 -1.398 TD -0.0036 Tc 0.0478 Tw (ticles were identified that provide background and descrip-)Tj 0 -1.401 TD -0.0063 Tc -0.0625 Tw (tive information on the types of peer support offered to police)Tj T* -0.0183 Tc -0.06 Tw (following 9/11.)Tj /F1 1 Tf 11 0 0 11 309 126 Tm -0.0041 Tc 0.0484 Tw (Review of the Literature)Tj /TT2 1 Tf 10 0 0 10 327 102.66 Tm -0.0035 Tc -0.0322 Tw (Much of the material written to date about peer support,)Tj -1.8 -1.401 TD -0.0024 Tc 0.125 Tw (peer programs, and police is anecdotal. Indeed, there is a)Tj T* -0.0032 Tc 0.1188 Tw (paucity of empirical research into the effectiveness of the)Tj ET endstream endobj 158 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 160 0 obj << /Length 8699 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (31)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.004 Tc -0.0393 Tw (available peer programs \(Hammond & Brooks, 2001\). How-)Tj 0 -1.398 TD -0.0036 Tc -0.043 Tw [(ever)35.4(, there is some empirical evidence suggesting that police)]TJ 0 -1.401 TD -0.0033 Tc -0.0045 Tw (are more likely to seek out the immediate and informal sup-)Tj T* -0.003 Tc -0.0531 Tw (port of peers to deal with day-to-day stressas well as in the)Tj 0 -1.398 TD -0.0035 Tc -0.003 Tw (midst of a critical incident or during the ongoing rescue and)Tj 0 -1.401 TD -0.0038 Tc -0.0616 Tw [(recovery phases \(Alexander & )17.6(W)94(alker)35.2(, 1994\).)]TJ /TT7 1 Tf 11 0 0 11 66 619.35 Tm 0.0093 Tc 0.1254 Tw [(Police Peer Suppor)-4.3(t and Peer Support Pr)31.1(ograms)]TJ /TT2 1 Tf 10 0 0 10 84 586.65 Tm -0.0034 Tc 0.0306 Tw (The goal of a support program is to enhance employee)Tj -1.8 -1.401 TD -0.0114 Tc -0.062 Tw (well-being, promote job performance, increase organizational)Tj 0 -1.398 TD -0.0045 Tc -0.0623 Tw [(ef)22.5(ficiency)58.5(, and help facilitate a work-family balance \(Akabas)]TJ 0 -1.401 TD -0.0144 Tc -0.0625 Tw (& Kurzman, 2005; Masi et al., 2002\).)Tj 1.8 -2.001 TD -0.0038 Tc 0.0238 Tw [(Finn and )14.3(T)73(omz \(1997\) conducted a literature review of)]TJ -1.8 -1.398 TD -0.004 Tc -0.0625 Tw (law enforcement stress and stress programs. In addition, they)Tj 0 -1.401 TD -0.0039 Tc -0.0217 Tw (conducted in-person and telephone interviews with program)Tj T* -0.0052 Tc -0.0625 Tw (directors, mental health providers, law enforcement adminis-)Tj 0 -1.398 TD -0.0033 Tc -0.0457 Tw (trators, union and association officials, family members, and)Tj 0 -1.401 TD -0.0113 Tc -0.0625 Tw (civilians associated with law enforcement personnel at a num-)Tj T* -0.0033 Tc -0.0294 Tw [(ber of agencies. Their research project was sponsored by the)]TJ 0 -1.398 TD 0.0716 Tw (National Institute of Justice \(NIJ\) and was informed by an)Tj 0 -1.401 TD -0.0032 Tc 0.0042 Tw (advisory board comprised of police psychologists and prac-)Tj T* -0.0136 Tc -0.0625 Tw [(titioners. Finn and )16.4(T)72.2(omz \(1997\) complied with the recommen-)]TJ 0 -1.398 TD -0.0114 Tc -0.0622 Tw (dations of numerous law enforcement mental health providers)Tj 0 -1.401 TD -0.0037 Tc -0.0383 Tw (who had convened in 1995 at a law enforcement symposium)Tj T* -0.0034 Tc 0.0492 Tw (sponsored by the Federal Bureau of Investigation.)Tj 1.8 -1.998 TD -0.0038 Tc 0.0168 Tw [(Finn and )17.1(T)70(omz \(1998\) found that peer support services)]TJ -1.8 -1.401 TD -0.0031 Tc -0.0375 Tw (offer a beneficial outlet for officers unwilling or not ready to)Tj T* -0.0089 Tc -0.0621 Tw (seek professional help. Such services were furthermore found)Tj 0 -1.398 TD -0.0035 Tc 0.0917 Tw (to be effective in reducing the stigma and mistrust associ-)Tj 0 -1.401 TD 0.0006 Tc 0.125 Tw [(ated with professional mental health services. Finally)60.6(, al-)]TJ T* 0.0047 Tc (though many departments have found that establishing a)Tj 0 -1.398 TD -0.0033 Tc -0.0111 Tw (program may take some time, peer support services are ulti-)Tj 0 -1.401 TD -0.003 Tc 0.0428 Tw (mately widely accepted among officers. Overall, the report)Tj T* -0.0033 Tc -0.0078 Tw (advocates for peer support programs as an effective way for)Tj 0 -1.398 TD -0.0038 Tc 0.1108 Tw (law enforcement agencies to provide important support to)Tj 0 -1.401 TD -0.0082 Tc -0.0619 Tw [(their personnel \(Finn & )18.9(T)65.6(omz, 1998\).)]TJ 1.8 -2.001 TD -0.0156 Tc -0.0621 Tw [(Goldstein \(2005\) sampled 463 )14.4(V)115.6(ermont S)14.4(tate police of)17.4(fic-)]TJ -1.8 -1.398 TD -0.0036 Tc 0.0981 Tw [(ers via questionnaire in an effort)-6.6( to understand and assess)]TJ 0 -1.401 TD -0.0029 Tc 0.125 Tw (the challenges related to the delivery of peer support ser-)Tj T* -0.0033 Tc -0.0087 Tw (vices. The survey compared utilization of services with per-)Tj 0 -1.398 TD -0.0123 Tc -0.0625 Tw (ceived stigma among officers. Of those surveyed, the majority)Tj 0 -1.401 TD -0.0019 Tc 0.1249 Tw [(had not used peer services; thus the results indicated that)]TJ T* 0.0318 Tc 0.125 Tw (officers who sought help were frequently stigmatized)Tj 0 -1.398 TD -0.0035 Tc 0.0393 Tw (\(Goldstein, 2005\). These results also indicated that officers)Tj 25.5 64.398 TD 0.0706 Tw (who sought help were less influenced by perceived stigma)Tj 0 -1.398 TD 0.0211 Tw (than those who had not. Goldstein posited that these results)Tj 0 -1.401 TD -0.0032 Tc 0.0451 Tw [(may be indicative of a greater need for services because of)]TJ T* 0.053 Tw (extreme stress or other crises. This study also points to the)Tj 0 -1.398 TD -0.0036 Tc 0.0085 Tw (need for empirical research to determine what interventions)Tj 0 -1.401 TD -0.004 Tc -0.026 Tw (and programs work best for whom.)Tj 1.8 -2.001 TD -0.0034 Tc -0.0307 Tw [(Communication strategies and styles are traits that have)]TJ -1.8 -1.398 TD -0.0036 Tc 0.0761 Tw (been studied among police. In terms of informal peer sup-)Tj 0 -1.401 TD -0.0037 Tc -0.0106 Tw (port, Stephens and Long \(2000\) examined social support, as)Tj T* 0.0034 Tc 0.125 Tw (measured by communication with police supervisors and)Tj 0 -1.398 TD -0.0033 Tc 0.1217 Tw [(peers, as a buffer of work-related traumatic stress. In this)]TJ 0 -1.401 TD 0.0116 Tw [(study)62.7(, 527 of)14.7(ficers in New Zealand, representing a distribu-)]TJ T* -0.0059 Tc -0.0625 Tw (tion in rank, were surveyed. The questionnaire included mea-)Tj 0 -1.398 TD 0.0265 Tc 0.125 Tw (sures of psychological symptoms, physical symptoms,)Tj 0 -1.401 TD -0.0036 Tc 0.0079 Tw (traumatic events, and social support, including both content)Tj T* -0.0041 Tc 0.051 Tw (of communication \(non-job communication, negative work)Tj 0 -1.398 TD 0.045 Tw (communications, positive work communications, and com-)Tj 0 -1.401 TD -0.0025 Tc 0.125 Tw (munications about all disturbing experiences\) and ease of)Tj T* -0.0036 Tc 0.0278 Tw (talking about trauma. The overall findings supported previ-)Tj 0 -1.398 TD -0.0037 Tc 0.0714 Tw (ous research emphasizing the importance of social support)Tj 0 -1.401 TD -0.0194 Tc -0.0622 Tw [(\(Boscarino, 1995; Joseph et al., 1993; Norris & Kaniasty)61.6(, 1996;)]TJ T* -0.0145 Tc -0.0623 Tw [(Solomon & Mikulincer)36.5(, 1990; S)15.5(tephens & Long, 2000\). )15.7(These)]TJ 0 -1.398 TD -0.0035 Tc 0.0122 Tw (authors found that the ease of talking about traumatic expe-)Tj 0 -1.401 TD -0.0038 Tc 0.1029 Tw (riences in the workplace or positive communication about)Tj T* -0.0036 Tc -0.0386 Tw (work-related issues moderated the effects of traumatic stress)Tj 0 -1.398 TD 0.038 Tw [(for of)17.4(ficers. However)38.4(, although some types of communica-)]TJ 0 -1.401 TD -0.0029 Tc 0.002 Tw (tion buffer stress at moderate levels, other types may not be)Tj T* -0.0036 Tc 0.1222 Tw (protective. These findings highlight the importance of the)Tj 0 -1.398 TD 0.0519 Tw (source of support \(supervisor versus peer\) and suggest that)Tj 0 -1.401 TD -0.0089 Tc -0.0625 Tw (supervisors may not be in the best position to facilitate trauma)Tj T* -0.0062 Tc (reducing communication with supervisees concerning a criti-)Tj 0 -1.398 TD -0.0035 Tc 0.0825 Tw (cal incident or other traumatic event. This underscores the)Tj 0 -1.401 TD -0.0033 Tc -0.0463 Tw (importance of different sources of support and specific types)Tj T* -0.0036 Tc 0.0394 Tw (of communication, as well as the levels of the communica-)Tj 0 -1.398 TD -0.0028 Tc 0.0679 Tw [(tion. They argue that the results of this study highlight the)]TJ 0 -1.401 TD 0.011 Tc 0.125 Tw (need to develop interventions such as peer support pro-)Tj T* -0.0039 Tc -0.0613 Tw (grams \(Stephens & Long, 2000\).)Tj 1.8 -1.998 TD -0.0035 Tc 0.1158 Tw (A nationwide cross-sectional survey conducted in the)Tj -1.8 -1.401 TD -0.0033 Tc -0.0567 Tw (Norwegian police service looked at a variety of conditions in)Tj T* -0.0104 Tc -0.0621 Tw (the workplace that cause stress, including work-related events)Tj 0 -1.398 TD 0.0112 Tc 0.125 Tw (and situations encountered \(Berg, Hem, Lau, Haseth, &)Tj 0 -1.401 TD -0.0051 Tc -0.0625 Tw (Ekeberg, 2005\). Respondents were also asked whether a peer)Tj T* -0.0036 Tc -0.0343 Tw (support service had been established in their workplace. The)Tj 0 -1.398 TD -0.0034 Tc 0.1084 Tw (study found that perceived lack of support was viewed as)Tj 0 -1.401 TD -0.0036 Tc -0.0611 Tw (more severe in districts where peer support had been planned)Tj T* -0.0027 Tc 0.125 Tw (but not implemented. In districts that lacked peer support)Tj ET endstream endobj 161 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 163 0 obj << /Length 8714 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0053 Tc 0.0896 Tw [(32 )]TJ /TT3 1 Tf 2.1938 0 TD -0.0054 Tc 0.0922 Tw (Grauwiler, Barocas, and Mills Police Peer Support Programs)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0031 Tc -0.0194 Tw (services, police experienced all of the stress factors \(i.e., job)Tj 0 -1.398 TD -0.0052 Tc -0.0625 Tw [(pressure, lack of support, and work injuries\) more frequently)57.8(.)]TJ 0 -1.401 TD -0.0032 Tc 0.0838 Tw (This survey found that in districts where peer support ser-)Tj T* -0.0102 Tc -0.0625 Tw (vices were plannedbut not deliveredthere were relatively)Tj 0 -1.398 TD -0.0031 Tc -0.0146 Tw (high levels of stress. The authors note that they did not have)Tj 0 -1.401 TD -0.0036 Tc -0.0622 Tw (data addressing why peer support was not implemented in all)Tj T* -0.0037 Tc [(districts throughout the country)59.3(. In this study)62.3(, causality could)]TJ 0 -1.398 TD -0.0033 Tc 0.1013 Tw (not be assessed because the study was cross-sectional. In-)Tj 0 -1.401 TD -0.0029 Tc -0.0081 Tw [(terestingly)60.1(, police in Norway are normally unarmed, but the)]TJ T* -0.0034 Tc 0.0122 Tw (culture and reluctance to seek help are consistent with find-)Tj 0 -1.398 TD -0.017 Tc -0.062 Tw [(ings among other)34(, armed police populations \(Ber)10(g et al., 2005\).)]TJ /TT7 1 Tf 11 0 0 11 54 549.36 Tm 0.0046 Tc 0.1254 Tw (Role of Peer Support in the Aftermath of)Tj 0 -1.1836 TD 0.0181 Tc 0.125 Tw [(September 1)72.6(1, 2001)]TJ /TT2 1 Tf 10 0 0 10 72 516.66 Tm -0.003 Tc 0.1187 Tw (In a study of rescue and recovery workers \(including)Tj -1.8 -1.401 TD 0.0341 Tc 0.1249 Tw [(police\) from the )19(W)98.9(orld )19(T)38.9(rade Center Health Registry)]TJ T* -0.0038 Tc 0.125 Tw [(\(WTCHR\), a voluntary)59.2(, longitudinal cohort of individuals)]TJ 0 -1.398 TD -0.0134 Tc -0.0622 Tw (highly exposed to the 2001 WTC attack, Perrin and colleagues)Tj 0 -1.401 TD -0.0081 Tc -0.0625 Tw (\(2007\) found that emergency medical services/medical disas-)Tj T* -0.0032 Tc 0.1023 Tw (ter personnel and firefighters were twice as likely to have)Tj 0 -1.398 TD -0.0038 Tc 0.0517 Tw (current probable posttraumatic stress disorder \(PTSD\) than)Tj 0 -1.401 TD -0.0036 Tc 0.02 Tw (police. These authors note that police department screening)Tj T* -0.0015 Tc 0.125 Tw (procedures may result in a more psychologically resilient)Tj 0 -1.398 TD -0.0028 Tc -0.0325 Tw (workforce. They also posit that police may be more likely to)Tj 0 -1.401 TD -0.0032 Tc 0.0593 Tw (underreport symptoms of psychological distress for fear of)Tj T* -0.0037 Tc 0.1108 Tw (the negative consequences associated with this admission.)Tj 0 -1.398 TD -0.0077 Tc -0.0625 Tw (Perrin and colleagues \(2007\) argue that their findings demon-)Tj 0 -1.401 TD -0.0033 Tc 0.0244 Tw (strate a need for targeted interventions specific to the occu-)Tj T* 0.0208 Tc 0.125 Tw (pational diversity of workers responding to large-scale)Tj 0 -1.398 TD -0.0032 Tc 0.0558 Tw (disasters to mitigate any psychological adjustments associ-)Tj 0 -1.401 TD -0.0036 Tc -0.025 Tw (ated with this work.)Tj 1.8 -2.001 TD 0.0029 Tw (The literature reveals some interest in peer-based inter-)Tj -1.8 -1.398 TD -0.0034 Tc 0.1138 Tw (vention strategies for police officers to offset the possible)Tj 0 -1.401 TD 0.001 Tc 0.125 Tw (negative psychological consequences of cumulative work)Tj T* -0.0032 Tc 0.0868 Tw [(stress and, in particular)38.8(, exposure to critical incidents. Re-)]TJ 0 -1.398 TD -0.0036 Tc 0.0038 Tw (newed attention was given to intervention efforts to prevent)Tj 0 -1.401 TD -0.0037 Tc 0.0489 Tw (PTSD in first responders in both the academic and popular)Tj T* -0.0038 Tc 0.0333 Tw (press after the events of September 11, 2001 \(Hammond &)Tj 0 -1.398 TD -0.012 Tc -0.0617 Tw (Brooks, 2001; Jones, 2001\).)Tj 1.8 -2.001 TD -0.0035 Tc -0.0461 Tw [(A)58.7( great number of uniformed New )32.5(Y)103.7(ork City Police De-)]TJ -1.8 -1.401 TD -0.004 Tc -0.0439 Tw [(partment )-7.9(\(NYPD\) of)17(ficers had significant exposure to )14.3(W)96.8(orld)]TJ 0 -1.398 TD -0.008 Tc -0.0625 Tw (Trade Center \(WTC\) attacks in 2001. In fact, more than 5,000)Tj 0 -1.401 TD -0.0052 Tc -0.0622 Tw (officers responded within the first 2 days, and another 25,000)Tj T* -0.0035 Tc -0.0006 Tw (officers worked at ground zero, the morgues, and the Staten)Tj 0 -1.398 TD 0.009 Tc 0.125 Tw (Island landfill over a 6-month period \(Castellano, 2003;)Tj 25.5 63.798 TD -0.0033 Tc 0.0244 Tw (Dowling, Moynihan, Genet, & Lewis, 2006\). Still there are)Tj 0 -1.398 TD -0.0047 Tc -0.0622 Tw (little data on the long-term impact of this exposure, including)Tj 0 -1.401 TD -0.0033 Tc -0.0175 Tw (stress symptoms and other related psychological adjustment)Tj T* -0.006 Tc -0.0625 Tw (issues \(Dowling et al., 2006\).)Tj 1.8 -1.998 TD -0.0169 Tc [(In November 2001, the New )34.1(Y)99.3(ork City Police Department)]TJ -1.8 -1.401 TD -0.0029 Tc 0.125 Tw (mandated that all 55,000 employees, including uniformed)Tj T* 0.001 Tc (members, attend mental health counseling sessions to re-)Tj 0 -1.398 TD 0.0012 Tc (lieve the stress and strain imposed on them by the WTC)Tj 0 -1.401 TD -0.0015 Tc (attacks and its aftermath \(Jones, 2001\). The departmental)Tj T* -0.0037 Tc 0 Tw (mandate was a response to the known stigma and resistance)Tj 0 -1.398 TD -0.012 Tc -0.0621 Tw (associated with help seeking for psychological distress among)Tj 0 -1.401 TD -0.0035 Tc 0.0211 Tw (police. It was thought that the mandate would eliminate the)Tj T* -0.0031 Tc 0.1237 Tw (perception of any stigma because everyone was forced to)Tj 0 -1.398 TD -0.0037 Tc -0.0381 Tw (attend \(Jones, 2001\). The program was implemented in part-)Tj 0 -1.401 TD -0.0013 Tc 0.125 Tw (nership with Columbia University and offered individual,)Tj T* -0.0032 Tc 0.0135 Tw (group, and family assistance. This three-tiered approach re-)Tj 0 -1.398 TD -0.0037 Tc -0.0513 Tw (ceived financial support from the Police Foundation and was)Tj 0 -1.401 TD -0.017 Tc -0.0622 Tw (modeled after a similar approach utilized in Okalahoma City in)Tj T* -0.0037 Tc -0.01 Tw (1995 in which first responders were mandated to participate)Tj 0 -1.398 TD 0.0325 Tw (in counseling sessions \(Jones, 2001\).)Tj 1.8 -2.001 TD -0.0036 Tc -0.0562 Tw (The issue of time has important implications for disaster)Tj -1.8 -1.401 TD -0.0031 Tc -0.0075 Tw (mental health and early intervention \(Reyes & Elhai, 2004\).)Tj 0 -1.398 TD 0.0877 Tw [(Generally)62.9(, it is believed that the sooner the intervention is)]TJ 0 -1.401 TD -0.0034 Tc 0.1039 Tw [(provided the better it is for individuals exposed to critical)]TJ T* -0.0148 Tc -0.0625 Tw [(incidents \(Reyes & Elhai\). )36.2(Y)101.4(et, almost a year later)39.2(, only 15,000)]TJ 0 -1.398 TD -0.0037 Tc -0.0461 Tw (of the 55,000 NYPD officers had attended the mandated ses-)Tj 0 -1.401 TD -0.0374 Tw (sions \(Jones, 2001\).)Tj /TT7 1 Tf 1.8 -2.001 TD -0.0048 Tc 0.025 Tw (The CISM model)Tj /TT2 1 Tf 6.765 0 TD -0.0038 Tc 0.0275 Tw (: Critical Incident Stress Management)Tj -8.565 -1.398 TD -0.0037 Tc 0.0312 Tw (\(CISM\) is an intervention model that was designed specifi-)Tj 0 -1.401 TD -0.0031 Tc 0.0207 Tw [(cally for emer)17.9(gency response personnel and, later)35.9(, the mili-)]TJ T* -0.0172 Tc -0.0623 Tw [(tary \(Sheehan, Everly)63.8(, & Langlieb, 2004\). CISM is the primary)]TJ 0 -1.398 TD -0.0034 Tc 0.04 Tw (peer-led intervention model utilized after a critical incident)Tj 0 -1.401 TD -0.0036 Tc -0.0185 Tw [(today)59.4(. CISM comprises multiple intervention techniques for)]TJ T* -0.0037 Tc 0.1032 Tw [(individual and group intervention. However)35.3(, the empirical)]TJ 0 -1.398 TD -0.0367 Tw (research on CISM is limited and unclear because of method-)Tj 0 -1.401 TD -0.0081 Tc -0.0625 Tw (ological limitations, including timeliness of interventions and)Tj T* -0.0622 Tw [(concerns about model fidelity \(e.g., strict adherence to model)]TJ 0 -1.398 TD -0.0033 Tc -0.0522 Tw (protocol\), which is believed to be critical to the effectiveness)Tj 0 -1.401 TD -0.0057 Tc -0.0622 Tw (of each component of CISM \(Everly & Mitchell, 1999, 2000;)Tj T* -0.0036 Tc 0.0388 Tw [(Hammond & Brooks, 2001\). Despite this lack of research,)]TJ 0 -1.398 TD 0.0091 Tc 0.125 Tw (CISM techniques and methodologies have been adopted)Tj 0 -1.401 TD -0.0033 Tc 0.0411 Tw [(worldwide and have recently been made an integral part of)]TJ T* -0.0035 Tc 0.008 Tw (the United Nations critical incident protocols.)Tj 1.8 -1.998 TD -0.004 Tc 0.0909 Tw (Although some scholars and law enforcement person-)Tj -1.8 -1.401 TD -0.0037 Tc 0.0856 Tw (nel advocate for widespread training and use of the CISM)Tj ET endstream endobj 164 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 166 0 obj << /Length 9245 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (33)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0036 Tc -0.0339 Tw (model, others point to the mixed empirical findings and cau-)Tj 0 -1.398 TD -0.0031 Tc 0.034 Tw (tion that this form of intervention may in fact cause further)Tj 0 -1.401 TD -0.0059 Tc -0.0622 Tw (harm to some individuals \(Deahl, 2000; Dowling et al., 2006;)Tj T* -0.0032 Tc 0.0049 Tw [(Reyes & Elhai, 2004\). )32.7(Y)104(et scholars on both sides of this de-)]TJ 0 -1.398 TD -0.0052 Tc -0.0623 Tw (bate agree that more research is needed \(Bisson, Churchill, &)Tj 0 -1.401 TD -0.0048 Tc -0.0622 Tw [(W)93(essely)61.2(, 2001; Sijbrandij, Olf)16.2(f, Reitsma, Carlier)40.2(, & Gersons,)]TJ T* -0.0032 Tc -0.046 Tw [(2006; )18.1(W)94.6(essely & Deahl, 2003\). )18(The potentially lasting nega-)]TJ 0 -1.398 TD -0.0033 Tc 0.105 Tw (tive psychological effects of such exposure also speaks to)Tj 0 -1.401 TD -0.0034 Tc 0.0245 Tw (the need for multiple intervention strategies that can be uti-)Tj T* -0.0105 Tc -0.0624 Tw [(lized over time and in some cases over years \(Scurfield, )13.6(V)60.7(iola,)]TJ 0 -1.398 TD -0.0039 Tc -0.0583 Tw [(Platoni, & Colon, 2003\). )49.9(Although after September 1)32.1(1)2.5( CISM)]TJ 0 -1.401 TD -0.0034 Tc 0.0962 Tw (was provided to police officers and some firefighters, still)Tj T* 0.0075 Tw (other first responders, including emergency medical techni-)Tj 0 -1.398 TD -0.0038 Tc -0.0066 Tw [(cians \(EMT)68.2(s\) and paramedics within New )29.5(Y)103.4(ork)53.2(s 9-1-1 sys-)]TJ 0 -1.401 TD -0.0044 Tc 0 Tw (tems,)Tj 5.8 0 0 5.8 87.21 530.01 Tm 0 Tc ( )Tj 10 0 0 10 88.89 526.65 Tm -0.0037 Tc 0.0507 Tw (were not offered CISM or other intervention services)Tj -2.289 -1.401 TD -0.0214 Tc -0.06 Tw (\(Dionne, 2002\).)Tj /TT7 1 Tf 1.8 -1.998 TD -0.0046 Tc 0.105 Tw [(EIU, POPP)124.4(A, and Cop-2-Cop)]TJ /TT2 1 Tf 12.159 0 TD -0.0039 Tc 0.1068 Tw [(: )14.2(Three established peer)]TJ -13.959 -1.401 TD -0.0037 Tc 0.045 Tw (programs specializing in the unique mental health needs of)Tj T* -0.0033 Tc 0.03 Tw [(police in New )32.7(Y)103.9(ork City and New Jersey provided services)]TJ 0 -1.398 TD -0.0037 Tc -0.035 Tw (immediately following the WTC attacks in 2001. These pro-)Tj 0 -1.401 TD -0.018 Tc -0.0625 Tw (grams included the Early Intervention Unit \(EIU\), a peer-based)Tj T* -0.0037 Tc -0.0375 Tw (program internal to the NYPD that comprises police officers)Tj 0 -1.398 TD -0.0038 Tc -0.0591 Tw [(and civilians; the Police Or)14.2(ganization Providing Peers )53.4(Assis-)]TJ 0 -1.401 TD -0.004 Tc 0.0342 Tw [(tance \(POPP)86(A\), an independent nonprofit program external)]TJ T* -0.0039 Tc 0.0588 Tw (to the NYPD comprising retired and active NYPD officers)Tj 0 -1.398 TD -0.0037 Tc 0.0175 Tw (who volunteer as peer support officers; and Cop-2-Cop \(lo-)Tj 0 -1.401 TD -0.0077 Tc -0.0625 Tw (cated in New Jersey\), which is external to all departments and)Tj T* -0.0054 Tc -0.062 Tw [(funded by the state \(Ussery & )21.8(W)98.4(aters, 2006\). Cop-2-Cop was)]TJ 0 -1.398 TD -0.0034 Tc -0.0307 Tw (established as a crisis intervention help-line for law enforce-)Tj 0 -1.401 TD -0.0054 Tc -0.0625 Tw (ment personnel throughout the stateincluding law enforce-)Tj T* -0.0086 Tc -0.0622 Tw (ment officers and fire and emergency service personneland)Tj 0 -1.398 TD -0.0031 Tc -0.043 Tw (is staffed by retired peers from each of the respective profes-)Tj 0 -1.401 TD -0.0037 Tc 0.0919 Tw [(sions. )50.3(All three programs provided on-site and of)17.3(f-site de-)]TJ T* -0.0033 Tc 0.0728 Tw (fusing and debriefing, as well as hotline services, after the)Tj 0 -1.398 TD 0.0943 Tw (attacks, and indeed they continue to provide ongoing peer)Tj 0 -1.401 TD -0.0073 Tc -0.0625 Tw (counseling and crisis intervention services \(Castellano, 2003;)Tj T* -0.0163 Tc -0.0616 Tw (Dowling et al., 2006\).)Tj 1.8 -1.998 TD 0.0105 Tc 0.125 Tw (Proponents of peer support programs have long ad-)Tj -1.8 -1.401 TD -0.0036 Tc -0.0375 Tw (dressed the potential negative toll of cumulative police work)Tj T* -0.0033 Tc 0.0411 Tw (stress and the need to protect officers by providing compe-)Tj 0 -1.398 TD 0.0019 Tc 0.125 Tw (tent mental health services that tend to their unique con-)Tj 0 -1.401 TD -0.0041 Tc 0.0112 Tw [(cerns. Programs such as POPP)85.9(A)58.1( and Cop-2-Cop have made)]TJ T* -0.0034 Tc -0.0307 Tw (great efforts in establishing services that could engage offic-)Tj 0 -1.398 TD 0.0916 Tw (ers in a confidential venue to overcome their resistance to)Tj 0 -1.401 TD -0.0032 Tc -0.0225 Tw (help seeking. Confidential service delivery is believed to re-)Tj T* -0.0035 Tc 0.1161 Tw (duce the threat of stigma and other negative attitudes and)Tj 25.5 64.2 TD -0.0005 Tc 0.125 Tw (beliefs about mental health services within police depart-)Tj 0 -1.398 TD -0.0033 Tc -0.0422 Tw [(ments and precincts \(Dowling et al., 2006; Ussery & )14.7(W)97.5(aters,)]TJ 0 -1.401 TD -0.0516 Tc 0 Tw (2006\).)Tj 1.8 -2.001 TD -0.0036 Tc -0.0156 Tw (The intervention efforts made after the WTC attacks by)Tj -1.8 -1.398 TD -0.0041 Tc -0.0259 Tw [(POPP)85.9(A)58.1( and Cop-2-Cop are documented in a few descriptive)]TJ 0 -1.401 TD -0.0016 Tc 0.125 Tw (reports that detail both the research efforts as well as ac-)Tj T* 0.0231 Tc (counts of the interventions employed to assist officers)Tj 0 -1.398 TD -0.0036 Tc -0.0493 Tw [(\(Castellano, 2003; Dowling et al., 2006\). POPP)86.4(A, in partner)17.4(-)]TJ 0 -1.401 TD -0.0031 Tc 0.0249 Tw [(ship with Project Liberty)59.9(, developed a survey and collected)]TJ T* -0.029 Tc -0.0625 Tw (data, between December 2002 and December 2003, from 28,000)Tj 0 -1.398 TD -0.0086 Tc -0.0623 Tw (uniformed members of the NYPD who had participated in the)Tj 0 -1.401 TD -0.0017 Tc 0.125 Tw [(WTC rescue and recovery ef)13.3(forts. )13.3(This survey)64.3(, which as-)]TJ T* -0.0031 Tc 0.0392 Tw (sessed the officers stress symptoms, yielded some striking)Tj 0 -1.398 TD 0.0073 Tc 0.1251 Tw [(data. However)37.3(, the authors caution that these results are)]TJ 0 -1.401 TD -0.003 Tc 0.0927 Tw [(limited for two reasons. First, the authors did not rely on)]TJ T* -0.0088 Tc -0.0621 Tw (existing scales or structured clinical interviews. Second, there)Tj 0 -1.398 TD -0.0036 Tc 0.0788 Tw (is no comparison data prior to September 11, 2001, which)Tj 0 -1.401 TD -0.0032 Tc 0.125 Tw (would provide pre-event or baseline data \(Dowling et al.,)Tj T* -0.0516 Tc 0 Tw (2006\).)Tj 1.8 -1.998 TD -0.0032 Tc 0.0986 Tw (Nevertheless, the results of this survey indicated high)Tj -1.8 -1.401 TD -0.0076 Tc -0.0621 Tw (levels of behavioral, emotional, physical, and cognitive stress)Tj T* 0.0146 Tc 0.125 Tw (symptoms. For instance, 13.3% of the officers reported)Tj 0 -1.398 TD -0.0033 Tc 0.0941 Tw (hypervigilance, and another 7.8% reported social isolation)Tj 0 -1.401 TD -0.0034 Tc 0.1175 Tw (and withdrawal. Increased irritability was reported among)Tj T* -0.0035 Tc -0.0282 Tw (17.2% of the officers, and 12.9% reported increased sadness)Tj 0 -1.398 TD -0.0098 Tw [(and tearfulness. )50.7(Additionally)62.5(, 14.1% of the of)14.5(ficers reported)]TJ 0 -1.401 TD -0.0033 Tc -0.0572 Tw (fatigue and exhaustion, and 9.2% reported difficulty concen-)Tj T* -0.0161 Tw (trating \(Dowling et al., 2006\). Despite the limitations of this)Tj 0 -1.398 TD -0.0031 Tc 0.0744 Tw (data set, the results clearly underscore the ongoing lack of)Tj 0 -1.401 TD -0.0034 Tc 0.055 Tw (available information on the effects of this response effort.)Tj T* -0.0036 Tc -0.0183 Tw (Such findings further draw attention to the need for ongoing)Tj 0 -1.398 TD -0.0108 Tc -0.0622 Tw (research into the immediate and long-term effects on the men-)Tj 0 -1.401 TD 0.0084 Tc 0.125 Tw (tal health of police officers exposed to critical incidents)Tj T* -0.017 Tc -0.0617 Tw (\(Dowling et al., 2006\).)Tj 1.8 -1.998 TD 0 Tc 0 Tw ( )Tj /TT7 1 Tf 0.195 0 TD -0.0047 Tc -0.0575 Tw (WTC screening program)Tj /TT2 1 Tf 9.735 0 TD -0.0031 Tc -0.0585 Tw [(: In July 2002 the Mount Sinai)]TJ -11.73 -1.401 TD -0.0039 Tc 0.0425 Tw (School of Medicine established a comprehensive screening)Tj T* -0.0137 Tc -0.0624 Tw [(program to evaluate the mental health status of the 2001 )16.4(W)96.1(orld)]TJ 0 -1.398 TD -0.0033 Tc -0.0415 Tw (Trade Center rescue and recovery workers, including police,)Tj 0 -1.401 TD -0.0089 Tc -0.0625 Tw (construction trades, utilities, sanitation, firefighters, and other)Tj T* -0.0036 Tc 0.0825 Tw [(first responders. Smith and colleagues \(2004\) published a)]TJ 0 -1.398 TD -0.0587 Tw (report that examined a subset of participants, 1,138 individu-)Tj 0 -1.401 TD -0.0099 Tc -0.0622 Tw (als, who were screened between July 16, 2002, and December)Tj T* -0.0033 Tc 0.0406 Tw (31, 2002, approximately 10 to 16 months after the incident)Tj 0 -1.398 TD -0.0029 Tc -0.0195 Tw (\(Smith et al., 2004\). The majority of study participants were)Tj 0 -1.401 TD -0.0103 Tc -0.0622 Tw (men \(91%\) and non-Hispanic White \(58%\). Several standard-)Tj T* -0.0034 Tc 0.0534 Tw (ized measures were used to screen for symptoms of antici-)Tj ET endstream endobj 167 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 169 0 obj << /Length 8774 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0053 Tc 0.0896 Tw [(34 )]TJ /TT3 1 Tf 2.1938 0 TD -0.0054 Tc 0.0922 Tw (Grauwiler, Barocas, and Mills Police Peer Support Programs)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0099 Tc -0.0625 Tw (pated post-disaster mental health conditions \(including GHQ-)Tj 0 -1.398 TD -0.0177 Tc -0.0622 Tw (28, PTSD Symptom Checklist, CAGE, and Sheehan Disability)Tj 0 -1.401 TD -0.0033 Tc -0.0124 Tw [(Scale\). )53.8(Approximately half \(51%\) of the participants, on the)]TJ T* -0.0034 Tc -0.017 Tw (basis of one or more measures, met the threshold criteria for)Tj 0 -1.398 TD -0.007 Tc -0.0625 Tw (a clinical mental health evaluation \(Smith et al., 2004\).)Tj 1.8 -2.001 TD 0.002 Tc 0.125 Tw (Approximately 20% of the participants also reported)Tj -1.8 -1.401 TD -0.0034 Tc 0.0438 Tw (symptoms that meet the threshold for PTSD; of this group,)Tj 0 -1.398 TD 0.024 Tw (13% met the full diagnostic criteria for PTSD \(Smith et al.,)Tj 0 -1.401 TD -0.0033 Tc -0.0125 Tw (2004\). Furthermore, only 3% of all participants reported ac-)Tj T* -0.0035 Tc 0.0725 Tw (cessing mental health services prior to participating in this)Tj 0 -1.398 TD -0.003 Tc 0.125 Tw (screening program. The findings are limited because they)Tj 0 -1.401 TD -0.0068 Tc -0.0625 Tw (were not categorized by occupational group and the research-)Tj T* -0.0036 Tc 0.035 Tw (ers may have lacked knowledge about the size of the WTC)Tj 0 -1.398 TD 0.0035 Tc 0.125 Tw (rescue and recovery worker populations; a selection bias)Tj 0 -1.401 TD -0.0036 Tc 0.0061 Tw (might exist in that individuals who came forward to partici-)Tj T* -0.003 Tc -0.028 Tw (pate in the screening may have done so because they experi-)Tj 0 -1.398 TD -0.0054 Tc -0.0625 Tw (enced greater exposure and/or symptoms; and questionnaires)Tj 0 -1.401 TD -0.0061 Tc -0.0622 Tw (that were utilized in the screening were validated using popu-)Tj T* -0.0032 Tc 0.02 Tw [(lations other than the one under studyincluding psychiat-)]TJ 0 -1.398 TD -0.0056 Tc -0.0622 Tw (ric patients and women \(Smith et al., 2004\).)Tj /TT7 1 Tf 11 0 0 11 54 417.36 Tm 0.0182 Tc 0 Tw (Summary)Tj /TT2 1 Tf 10 0 0 10 72 397.65 Tm -0.0035 Tc -0.0494 Tw (The literature reviewed above highlights the lack of evi-)Tj -1.8 -1.401 TD -0.0042 Tc -0.0625 Tw (dence-based intervention practices with first responders gen-)Tj 0 -1.398 TD -0.005 Tc -0.0622 Tw (erally and indicates a need to rigorously test the interventions)Tj 0 -1.401 TD 0.0005 Tc 0.125 Tw (currently utilized in large-scale disaster mental health re-)Tj T* -0.0036 Tc 0.0165 Tw (sponse efforts for all responders including police \(Scurfield)Tj 0 -1.398 TD -0.0142 Tc -0.0625 Tw [(et al., 2003\). In particular)39.8(, the components of the CISM model,)]TJ 0 -1.401 TD -0.0037 Tc 0.0239 Tw [(including interventions such as defusing, debriefing, demo-)]TJ T* 0.0002 Tc 0.125 Tw (bilization, one-on-one peer support counseling, and crisis)Tj 0 -1.398 TD -0.0036 Tc -0.0412 Tw (intervention, are all in need of further evaluation \(Hammond)Tj 0 -1.401 TD -0.0135 Tc -0.0625 Tw (& Brooks, 2001; Reyes & Elhai, 2004\).)Tj /F1 1 Tf 11 0 0 11 137.25 239.01 Tm 0.0207 Tc 0 Tw (DISCUSSION)Tj /TT2 1 Tf 10 0 0 10 72 215.64 Tm 0.0001 Tc 0.125 Tw (The literature reviewed in this paper underscores the)Tj -1.8 -1.398 TD -0.0035 Tc -0.01 Tw (current limitations of the empirical research on peer support)Tj 0 -1.401 TD -0.0413 Tw (programs for police officers. It furthermore sheds some light)Tj T* -0.0034 Tc 0.0687 Tw (on the existing state of disaster mental health intervention,)Tj 0 -1.398 TD 0.0957 Tw [(practice, and programming. In particular)38.6(, there are several)]TJ 0 -1.401 TD 0.0028 Tc 0.125 Tw (important issues that require attention. The first involves)Tj T* -0.0037 Tc -0.01 Tw (present gaps in knowledge about the peer intervention mod-)Tj 0 -1.398 TD -0.0035 Tc -0.0476 Tw [(els and programs currently in use for police. )50.7(Although CISM)]TJ 0 -1.401 TD -0.0622 Tw (is the dominant intervention model in which many peers pro-)Tj T* -0.0036 Tw (vide support, this model requires further empirical evidence)Tj 0 -1.398 TD -0.0032 Tc 0.0166 Tw [(to support widespread use after a critical incident \(Reyes &)]TJ 25.5 64.698 TD -0.0035 Tc -0.0605 Tw [(Elhai, 2004; )14.6(W)97.3(essely & Deahl, 2003\). )50.6(And though the imple-)]TJ 0 -1.398 TD -0.0033 Tc 0.11 Tw (mentation of peer programs has been widely approved by)Tj 0 -1.401 TD -0.0037 Tc -0.045 Tw (federal agencies and police organizations, such endorsement)Tj T* -0.0033 Tc 0.0372 Tw (is based largely upon observation, intuition, and conjecture)Tj 0 -1.398 TD -0.0216 Tc -0.0625 Tw [(\(Finn & )17.4(T)70.2(omz, 1998\). )47.4(Additionally)62.4(, more information is needed)]TJ 0 -1.401 TD -0.0035 Tc 0.0156 Tw (on peer models and staffing because many programs utilize)Tj T* -0.0162 Tc -0.0622 Tw (both professional mental health practitioners and trained peers.)Tj 0 -1.398 TD -0.0033 Tc -0.0445 Tw (Issues of model fidelity and training would also benefit from)Tj 0 -1.401 TD -0.0032 Tc 0.0186 Tw [(evaluation. Finally)59.8(, the research studies reviewed in this ar)17.8(-)]TJ T* -0.0022 Tc 0.125 Tw (ticle do not evaluate peer program effectiveness from the)Tj 0 -1.398 TD -0.0034 Tc 0.0068 Tw [(perspective of the of)14.6(ficers receiving peer services. )17.5(T)73.4(o)0.5( better)]TJ 0 -1.401 TD 0.0002 Tc 0.125 Tw (serve this invaluable population, efforts must be made to)Tj T* -0.0036 Tc -0.005 Tw (incorporate their views.)Tj 1.8 -1.998 TD -0.0031 Tc 0.0059 Tw (A critical issue in this review of the literature is the na-)Tj -1.8 -1.401 TD -0.0034 Tc 0.07 Tw (ture and focus of research conducted on police officers. In)Tj T* 0.0006 Tc 0.1251 Tw [(other words, what is it that studies have focused on? )48.7(Al-)]TJ 0 -1.398 TD -0.0042 Tc -0.0625 Tw (though researchers have examined police officer characteris-)Tj 0 -1.401 TD -0.0035 Tc 0.0275 Tw (tics and organizational culture, these studies do not address)Tj T* 0.0793 Tw (strategies for overcoming police resistance to services that)Tj 0 -1.398 TD -0.0034 Tc 0.0366 Tw [(promote psychological health and well-being. In particular)35.6(,)]TJ 0 -1.401 TD -0.0035 Tc -0.055 Tw (more studies that look at the interaction between officers and)Tj T* 0.0064 Tc 0.125 Tw (organizations are needed to understand what perpetuates)Tj 0 -1.398 TD 0.0007 Tc (the mistrust and stigma attached to job-related stress and)Tj 0 -1.401 TD -0.0033 Tc -0.0249 Tw [(help seeking in the workplace. Finally)62.7(, established peer sup-)]TJ T* -0.0038 Tc -0.022 Tw (port programs would benefit from evaluation.)Tj 1.8 -1.998 TD -0.0036 Tc 0.1067 Tw [(Additionally)59.4(, how police of)17.4(ficers provide one another)]TJ -1.8 -1.401 TD -0.0037 Tc -0.0306 Tw (with spontaneous or informal peer support during the course)Tj T* -0.0032 Tc 0.0582 Tw [(of a day)50.8(s work and in the aftermath of a disaster warrants)]TJ 0 -1.398 TD -0.0034 Tc -0.0188 Tw [(further study)62.6(. )14.6(This research would lend valuable insight into)]TJ 0 -1.401 TD 0.0022 Tc 0.125 Tw (how to train officers to enhance these skills \(such as the)Tj T* -0.003 Tc 0.0128 Tw (ability to assess for suicidal ideation, alcohol abuse, etc.\) to)Tj 0 -1.398 TD -0.0058 Tc -0.0625 Tw (avoid harmful \(though well intended\) interventions. Program)Tj 0 -1.401 TD -0.0034 Tc 0.0595 Tw (models must also be examined for issues of feasibility and)Tj T* -0.0029 Tc -0.0263 Tw [(flexibility)63.1(. Lastly)60.1(, due to the radiating impact of police work)]TJ 0 -1.398 TD -0.0034 Tc -0.0206 Tw (on police families, further investigation into strategies to as-)Tj 0 -1.401 TD -0.0032 Tc -0.047 Tw (sist police family members is needed.)Tj 3.6 -2.001 TD -0.0037 Tc 0.041 Tw (Several significant questions remain regarding the)Tj -3.6 -1.398 TD -0.0036 Tc 0.0106 Tw (effectiveness of peer support and peer programs in support-)Tj 0 -1.401 TD -0.0033 Tc 0.1187 Tw [(ing the psychological health and well-being of police and)]TJ T* -0.0022 Tc 0.125 Tw (other first responders. For instance, are peer programs an)Tj 0 -1.398 TD -0.0032 Tc -0.0394 Tw (appropriate intervention that can assist in protecting the psy-)Tj 0 -1.401 TD -0.0034 Tc 0.0712 Tw (chological health and well-being of police? Given the per-)Tj T* -0.0006 Tw (ceived threats to help seeking discussed above, what role, if)Tj 0 -1.398 TD -0.0031 Tc 0.1028 Tw [(any)62.9(, should the police or)14.9(ganization play in providing sup-)]TJ 0 -1.401 TD -0.0063 Tc -0.0626 Tw [(port services? )47.6(And will police of)17.7(ficers voluntarily utilize sup-)]TJ T* -0.013 Tc -0.0625 Tw (port services that are provided within their departments? What)Tj ET endstream endobj 170 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 172 0 obj << /Length 9419 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (35)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0043 Tc -0.0621 Tw [(ef)16.7(fect, if any)58.7(, does mandating services have on of)16.7(ficers)70.7( men-)]TJ 0 -1.398 TD -0.0031 Tc 0.0109 Tw [(tal health? Most importantly)62.9(, what can be done to of)17.9(fset the)]TJ 0 -1.401 TD -0.0037 Tc 0.0007 Tw (impact of long-term high-risk occupational stress and expo-)Tj T* -0.0132 Tc -0.0625 Tw (sure to manmade and natural disasters on psychological health)Tj 0 -1.398 TD -0.0039 Tc -0.06 Tw (and well-being?)Tj 1.8 -2.001 TD -0.0032 Tc -0.038 Tw [(Finally)62.8(, although the empirical research is limited, there)]TJ -1.8 -1.401 TD 0.004 Tc 0.125 Tw (is a wealth of anecdotal evidence that suggests that peer)Tj 0 -1.398 TD -0.0034 Tc 0.0431 Tw (programs may be well situated to certain high-risk occupa-)Tj 0 -1.401 TD -0.0035 Tc -0.0137 Tw (tions including police and other first responders. Of particu-)Tj T* -0.0103 Tc -0.0622 Tw (lar importance seems to be the likelihood of greater utilization)Tj 0 -1.398 TD -0.0052 Tc -0.0625 Tw (and retention in services facilitated by peers, individuals who)Tj 0 -1.401 TD -0.0029 Tc 0.0483 Tw (know first hand the realities of the day-to-day stress. Peers)Tj T* -0.0036 Tc 0.0793 Tw (also offer an alternative mechanism for engaging reluctant)Tj 0 -1.398 TD -0.0043 Tc -0.0622 Tw (officers in treatment and facilitating connection to traditional)Tj 0 -1.401 TD -0.0036 Tc 0.01 Tw (mental health services.)Tj /F1 1 Tf 11 0 0 11 66 488.01 Tm -0.001 Tc 0 Tw (Recommendations)Tj /TT2 1 Tf 10 0 0 10 84 464.64 Tm -0.0032 Tc -0.0277 Tw (Based on this review of the literature, the following key)Tj -1.8 -1.398 TD -0.0038 Tc 0.0656 Tw (factors should be included in program planning when con-)Tj 0 -1.401 TD -0.0092 Tc -0.0625 Tw (sidering the implementation of a peer support program. These)Tj T* -0.0141 Tc -0.062 Tw [(recommendations are drawn from the works of Finn and )16.1(T)71.7(omz)]TJ 0 -1.398 TD -0.006 Tc 0 Tw (\(199)Tj /TT1 1 Tf 1.815 0 TD 0 Tc (7)Tj /TT2 1 Tf 0.495 0 TD -0.004 Tc -0.038 Tw (\) and Robinson and Murdoch \(2003\).)Tj -0.51 -2.001 TD -0.0036 Tc -0.0356 Tw (An organization seeking to establish a peer support pro-)Tj -1.8 -1.401 TD -0.0034 Tw [(gram should determine which population it aims to serve. )50.3(A)]TJ 0 -1.398 TD 0.03 Tw (needs assessment allows an organization the opportunity to)Tj 0 -1.401 TD -0.0031 Tc -0.0206 Tw (identify the target population and to determine why services)Tj T* -0.0035 Tc 0.0118 Tw (are needed, and whether or not a peer program model is the)Tj 0 -1.398 TD -0.0034 Tc 0.0516 Tw [(appropriate fit. )53.5(A)58.8( mission statement and clear list of objec-)]TJ 0 -1.401 TD -0.0035 Tc 0.0931 Tw (tives should be established to assist in addressing relevant)Tj T* -0.0038 Tw (issues, such as program goals, and would facilitate outreach)Tj 0 -1.398 TD 0.065 Tw (to potential clients and funding sources.)Tj 1.8 -2.001 TD -0.0037 Tc 0.0633 Tw (Access and utilization issues are essential components)Tj -1.8 -1.401 TD -0.0036 Tc 0.1069 Tw (when considering peer programs for police and other first)Tj 0 -1.398 TD -0.0034 Tc 0.0669 Tw (responders. The need for privacy when accessing help and)Tj 0 -1.401 TD -0.0031 Tc 0.1221 Tw (confidentiality of services has been consistently shown to)Tj T* -0.0098 Tc -0.0625 Tw [(obstruct help seeking in the workplace \(W)77.2(oody)59.2(, 2005\). )20.2(There-)]TJ 0 -1.398 TD -0.0034 Tc 0.005 Tw (fore the following things need to be considered. It is impor-)Tj 0 -1.401 TD -0.003 Tc 0.0128 Tw (tant to determine the location of services \(i.e., whether they)Tj T* -0.0157 Tc -0.0625 Tw (will be implemented on-site or off\). Next, legal considerations,)Tj 0 -1.398 TD 0.0058 Tc 0.125 Tw (such as state laws and agency policies concerning client)Tj 0 -1.401 TD -0.0036 Tc 0.0962 Tw (disclosure problems to peers and therapists, must be com-)Tj T* -0.0073 Tc -0.0625 Tw (municated to all potential program participants. In addition, it)Tj 0 -1.398 TD -0.0035 Tc 0.1206 Tw (is useful to establish and disseminate written policies and)Tj 0 -1.401 TD -0.0034 Tc -0.0068 Tw (procedures that address such areas as peer selection criteria,)Tj T* -0.0029 Tc -0.0014 Tw [(client eligibility)63.1(, limits to confidentiality)60.1(, criteria for vetting)]TJ 25.5 64.8 TD -0.0035 Tc 0.0671 Tw (outside mental health resources, and other services offered)Tj 0 -1.398 TD -0.02 Tc -0.0621 Tw [(\(for a more comprehensive discussion see Finn & )13.1(T)71.8(omz, 1997\).)]TJ 0 -1.401 TD -0.0031 Tc 0.0814 Tw [(Finally)62.9(, it is also useful for the peer program to determine)]TJ T* -0.0037 Tc 0.125 Tw (relationships and established boundaries between the peer)Tj 0 -1.398 TD -0.0028 Tc (program, the organization, and the unions. Once these is-)Tj 0 -1.401 TD -0.0036 Tc 0.019 Tw (sues have been addressed it is important to consider how to)Tj T* 0.0019 Tw (market the program to reach the intended client population.)Tj 1.8 -1.998 TD 0.0075 Tc 0.125 Tw (Evidence informed practice requires monitoring and)Tj -1.8 -1.401 TD -0.0036 Tc 0.0456 Tw [(evaluation of the peer program. )53.4(An evaluation can help the)]TJ T* -0.0033 Tc 0.1022 Tw (program by revealing the extent to which it is effective)Tj 0 -1.398 TD -0.0032 Tc -0.01 Tw (describing the ways in which it is achieving the desired out-)Tj 0 -1.401 TD 0.0266 Tc 0.125 Tw (comesand offer recommendations to refine program)Tj T* -0.0047 Tc -0.0622 Tw (development. In the early stages of program implementation,)Tj 0 -1.398 TD -0.0037 Tc 0.1186 Tw (process and impact evaluations are useful for maintaining)Tj 0 -1.401 TD 0.0005 Tc 0.125 Tw (funding and to improve program operations and program)Tj T* -0.0035 Tc -0.0398 Tw [(ef)17.5(fectiveness \(Finn & )14.7(T)73.3(omz, 1997\). By integrating this valu-)]TJ 0 -1.398 TD -0.0026 Tc 0.125 Tw [(able feedback, not only do you address gaps in empirical)]TJ 0 -1.401 TD -0.0033 Tc 0.0011 Tw (knowledge, but you also assist in advancing the potential of)Tj T* -0.0035 Tc 0.0272 Tw (this unique peer-based intervention to the next level.)Tj /F1 1 Tf 11 0 0 11 400.89 432 Tm 0.021 Tc 0 Tw (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 321 414.66 Tm -0.0034 Tc -0.0101 Tw [(Akabas, S.H., & Kurzman, P)107.6(.A. \(2005\). )]TJ /TT7 1 Tf 15.924 0 TD -0.0039 Tc -0.0116 Tw [(W)94.1(ork and the work-)]TJ -14.724 -1.401 TD 0.0088 Tc 0.125 Tw (place: A resource for innovative policy and practice)Tj /TT2 1 Tf 22.251 0 TD 0 Tc 0 Tw (.)Tj -22.251 -1.401 TD -0.0084 Tc -0.062 Tw [(New )31.1(Y)104.8(ork: Columbia University Press.)]TJ -1.2 -1.8 TD -0.0034 Tc -0.0422 Tw [(Alexander)35.6(, D.A., & )18.2(W)94.4(alker)35.6(, L.G)119.6(. \(1994\). )51.2(A)58.8( study of methods)]TJ 1.2 -1.398 TD 0.0001 Tc 0.125 Tw (used by Scottish police officers to cope with work-in-)Tj 0 -1.401 TD -0.0035 Tc 0.0025 Tw (duced stress. )Tj /TT7 1 Tf 5.319 0 TD -0.0039 Tc 0.005 Tw (Stress Medicine, 10)Tj /TT2 1 Tf 7.8 0 TD -0.0036 Tc (, 131-138.)Tj -14.319 -1.8 TD -0.0032 Tc 0.0386 Tw [(Armeli, S., Eisenber)17.8(ger)35.8(, R., Fasolo, P)107.8(., & L)50.8(ynch, P)104.8(.)0( \(1998\).)]TJ 1.2 -1.401 TD -0.0058 Tc -0.062 Tw (Perceived organizational support and police performance:)Tj 0 -1.398 TD -0.0037 Tc -0.025 Tw (The moderating effects of socioemotional needs. )Tj /TT7 1 Tf 19.419 0 TD -0.005 Tc 0 Tw (Journal)Tj -19.419 -1.401 TD -0.076 Tw [(of Applied )-15.8(Psychology)49(, )-16(83)]TJ /TT2 1 Tf 10.131 0 TD -0.065 Tw (\(20\), 288-297.)Tj -11.331 -1.8 TD -0.0033 Tc 0.0559 Tw [(Asen, J., & Colon, I. \(1995\). )53.6(Acceptance and use of police)]TJ 1.2 -1.401 TD 0.0135 Tc 0.125 Tw (department employee assistance programs. )Tj /TT7 1 Tf 18.471 0 TD 0.0124 Tc 0 Tw (Employee)Tj -18.471 -1.398 TD -0.0083 Tc -0.0601 Tw [(Assistance Quar)-8.3(terly)]TJ /TT2 1 Tf 8.199 0 TD -0.005 Tc 0 Tw (, )Tj /TT7 1 Tf 0.432 0 TD -0.086 Tc (11)Tj /TT2 1 Tf 0.903 0 TD -0.0073 Tc -0.06 Tw (\(1\), 45-55.)Tj -10.734 -1.8 TD -0.0036 Tc -0.0623 Tw [(Ber)17.4(g, )56.4(A., Hem, E., Lau, B., Haseth, K., & Ekeber)17.4(g, O. \(2005\))]TJ 1.2 -1.401 TD 0.009 Tc 0.125 Tw (Stress in the Norwegian police service. )Tj /TT7 1 Tf 16.971 0 TD 0.0078 Tc 0 Tw (Occupational)Tj -16.971 -1.401 TD -0.0128 Tc -0.06 Tw (Medicine, 55)Tj /TT2 1 Tf 5.01 0 TD -0.0124 Tc (\(2\), 113-120.)Tj -6.21 -1.8 TD -0.0111 Tc -0.0626 Tw [(Bisson, R.S., Churchill, R., & )18.8(W)95.7(essely)63.9(, S. \(2002\). Psychologi-)]TJ 1.2 -1.398 TD 0.0156 Tc 0.125 Tw (cal debriefing for preventing post traumatic disorder)Tj 0 -1.401 TD -0.0045 Tc 0 Tw (\(PTSD\). )Tj /TT7 1 Tf 3.54 0 TD -0.0041 Tc -0.0438 Tw (Cochrane Database of Systematic Reviews)Tj /TT2 1 Tf 16.776 0 TD 0 Tc 0 Tw ( )Tj /TT7 1 Tf 0.204 0 TD -0.0067 Tc (2002)Tj /TT2 1 Tf -20.52 -1.401 TD 0.0589 Tc 0.3149 Tw [(\(Issue 2, )55.8(Art. No.: CD000560. DOI: 10.1002/)]TJ 0 -1.398 TD -0.0291 Tc -0.0621 Tw [(14651858.CD000560\). Retrieved )52.3(August 7, 2007, from http:/)]TJ 0 -1.401 TD -0.0105 Tc 0 Tw [(/www)58.5(.cochrane.or)16.5(g/reviews/en/ab000560.html)]TJ -1.2 -1.8 TD -0.0036 Tc 0.05 Tw (Boscarino, J.A. \(1995\). Posttraumatic stress and associated)Tj 1.2 -1.401 TD -0.0039 Tc 0.1067 Tw [(disorders among )17.1(V)64.3(ietnam veterans: )17.1(The significance of)]TJ ET endstream endobj 173 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 175 0 obj << /Length 11158 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0053 Tc 0.0896 Tw [(36 )]TJ /TT3 1 Tf 2.1938 0 TD -0.0054 Tc 0.0922 Tw (Grauwiler, Barocas, and Mills Police Peer Support Programs)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm 0.0035 Tc 0.125 Tw (combat exposure and social support. )Tj /TT7 1 Tf 15.585 0 TD 0.1252 Tw [(Journal of T)54.5(rau-)]TJ -15.585 -1.398 TD -0.0095 Tc -0.0617 Tw (matic Stress, 8, )Tj /TT2 1 Tf 6.021 0 TD -0.0113 Tc 0 Tw (317-336.)Tj -7.221 -1.8 TD -0.0035 Tc 0.0269 Tw (Castellano, C. \(2003\). 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Psychological debriefing: Controversy and)Tj 1.2 -1.401 TD -0.0035 Tc 0 Tw (challenge. )Tj /TT7 1 Tf 4.356 0 TD -0.004 Tc 0.0608 Tw (Australian and New Zealand Journal of Psy-)Tj -4.356 -1.398 TD -0.0142 Tc -0.0588 Tw [(chiatry)54.6(,)-1.2( 34)]TJ /TT2 1 Tf 4.065 0 TD -0.0149 Tc -0.06 Tw (\(6\), 929-939.)Tj -5.265 -1.8 TD -0.0095 Tc -0.0623 Tw [(Dionne, L. \(2002\). )50.7(After the fall: 9/1)32.5(1)50.5(s ef)14.5(fects on New )29.7(Y)103.7(ork)47.5(s)]TJ 1.2 -1.401 TD -0.0034 Tc -0.0336 Tw (EMS personnel extend far beyond symptoms of posttrau-)Tj T* -0.0029 Tc -0.03 Tw [(matic stress. It)51.1(s been a recovery derailed by lacking sup-)]TJ 0 -1.398 TD -0.003 Tc 0.1105 Tw (port systems & quashed by the absence of local & na-)Tj 0 -1.401 TD -0.0035 Tc 0.0525 Tw (tional recognition for EMS efforts & losses. )Tj /TT7 1 Tf 18.345 0 TD -0.0043 Tc 0.055 Tw (Journal of)Tj -18.345 -1.401 TD -0.0059 Tc -0.0616 Tw (Emergency Medical Services, 27)Tj /TT2 1 Tf 12.75 0 TD -0.0051 Tc -0.0625 Tw (\(9\), 36-8, 40-57.)Tj -13.95 -1.8 TD -0.012 Tc -0.0623 Tw [(Dowling, F)78(.)6.2(G)114(., Moynihan, G)111(., Genet, B., & Lewis, J. \(2006\). )54.2(A)]TJ 1.2 -1.398 TD -0.0037 Tc 0.0179 Tw (peer-based assistance program for officers with the New)Tj 0 -1.401 TD -0.0059 Tc -0.0622 Tw [(Y)107.3(ork City police department: Report on the ef)18.1(fects of Sep-)]TJ T* 0.0373 Tc 0.125 Tw [(tember 1)34.3(1)-0.9(, 2001. )]TJ /TT7 1 Tf 8.004 0 TD 0.0372 Tc [(American Journal of Psychiatr)-7.8(y)55(,)]TJ -8.004 -1.398 TD -0.033 Tc 0 Tw (163)Tj /TT2 1 Tf 1.41 0 TD -0.0304 Tc (\(1\),151-153.)Tj -2.61 -1.8 TD -0.0028 Tc -0.0417 Tw [(Everly)63.2(, G)117.2(.S.,Jr)54.2(. & Mitchell, J. \(1999\). )]TJ /TT7 1 Tf 14.796 0 TD -0.004 Tc -0.0421 Tw [(Critical incident str)32(ess)]TJ -13.596 -1.401 TD 0.0083 Tw (management \(CISM\): A new era and standard of care in)Tj T* -0.0037 Tc 0.0199 Tw (crisis intervention )Tj /TT2 1 Tf 7.47 0 TD -0.0033 Tc [(\(2nd ed.\). Ellicott City)59.7(, MD: Chevron)]TJ -7.47 -1.398 TD -0.0043 Tc -0.04 Tw (Publishing Corp.)Tj -1.2 -1.8 TD -0.0031 Tc -0.0606 Tw [(Everly)62.9(, G)116.9(.S., Jr)50.9(. & Mitchell, J. \(2000\). )17.9(The debriefing contro-)]TJ 1.2 -1.401 TD -0.0434 Tw [(versy and crisis intervention: )50.7(A)59( review of lexical and sub-)]TJ T* 0.0247 Tc 0.125 Tw (stantive issues. )Tj /TT7 1 Tf 6.921 0 TD 0.024 Tc (International Journal of Emergency)Tj -6.921 -1.398 TD -0.009 Tc -0.06 Tw (Mental Health, 2)Tj /TT2 1 Tf 6.546 0 TD -0.0088 Tc -0.0649 Tw (\(4\), 211-255.)Tj -7.746 -1.8 TD -0.0031 Tc -0.0582 Tw [(Finn, P)107.9(., & )18(T)70.7(omz, J.E. \(1997\). )]TJ /TT7 1 Tf 11.775 0 TD -0.0043 Tc -0.058 Tw [(Developing a law enfor)31.7(cement)]TJ -10.575 -1.401 TD -0.004 Tc 0.0701 Tw [(str)29(ess pr)32(ogram for officers and their families)]TJ /TT2 1 Tf 18.186 0 TD -0.0046 Tc 0.0586 Tw [(.)-5.6( W)96.2(ashing-)]TJ -18.186 -1.401 TD -0.0089 Tc -0.0623 Tw (ton, DC: U.S. Department of Justice, Office of Justice Pro-)Tj 0 -1.398 TD -0.0035 Tc 0.0013 Tw (grams, National Institute of Justice.)Tj -1.2 -1.8 TD -0.0034 Tc 0.076 Tw [(Finn, P)107.6(., & )17.6(T)70.4(omz, J. \(1998\). Using peer supporters to help)]TJ 1.2 -1.401 TD -0.0037 Tc -0.0483 Tw (address law enforcement. )Tj /TT7 1 Tf 10.206 0 TD -0.0041 Tc (FBI Law Enforcement Bulletin,)Tj -10.206 -1.401 TD -0.034 Tc 0 Tw (67)Tj /TT2 1 Tf 0.945 0 TD -0.0259 Tc -0.06 Tw (\(5\), 10-18.)Tj -2.145 -1.8 TD -0.0031 Tc -0.0102 Tw [(Gerstner)38.9(, C.R. & Day)62.9(, D.V)125.9(. \(1997\). Meta-analytic review of)]TJ 1.2 -1.398 TD -0.0059 Tc -0.062 Tw (leader-member exchange theory: Correlates and construct)Tj 0 -1.401 TD -0.0035 Tc 0 Tw (issues. )Tj /TT7 1 Tf 2.865 0 TD -0.0041 Tc 0.004 Tw [(Journal of )17.2(Applied Psychology)49.9(, 82)]TJ /TT2 1 Tf 13.674 0 TD -0.0036 Tc 0.005 Tw (\(6\), 827-844.)Tj -17.739 -1.8 TD 0.0299 Tw [(Goldstein, D.B. \(2005\). )50.4(A)58.7( comparison of utilization of peer)]TJ 1.2 -1.401 TD -0.0042 Tc -0.062 Tw [(support services and perceived stigma within the )16.9(V)118(ermont)]TJ 0 -1.398 TD -0.0032 Tc -0.0275 Tw (state police. )Tj /TT7 1 Tf 4.929 0 TD -0.0044 Tc -0.0298 Tw [(The For)28.6(ensic Examiner)106.6(, 14)]TJ /TT2 1 Tf 10.611 0 TD -0.0055 Tc 0 Tw (\(3\))Tj /TT7 1 Tf 1.155 0 TD 0 Tc (,)Tj /TT2 1 Tf 0.249 0 TD -0.0037 Tc -0.03 Tw [( 44-48.)]TJ 7.356 63.198 TD -0.0035 Tc 0.03 Tw (Greenstone, J.L. \(2000\). Peer support in a municipal police)Tj 1.2 -1.398 TD -0.004 Tc 0 Tw (department. )Tj /TT7 1 Tf 4.914 0 TD -0.0044 Tc -0.0397 Tw [(The For)28.6(ensic Examiner)106.6(, 9)]TJ /TT2 1 Tf 10.086 0 TD -0.0038 Tc -0.045 Tw (\(34\), 3336.)Tj -16.2 -1.8 TD -0.0114 Tw [(Hammond, J., & Brooks, J. \(2001\). )17.5(The )14.5(W)97(orld )14.5(T)37(rade Center)]TJ 1.2 -1.401 TD -0.0034 Tc 0.1219 Tw (attack helping the helpers: The role of critical incident)Tj T* -0.004 Tc -0.0475 Tw (stress management. )Tj /TT7 1 Tf 7.914 0 TD -0.0038 Tc -0.05 Tw (Critical Care, 5)Tj /TT2 1 Tf 6.207 0 TD [(\(6\), 315-317.)]TJ -15.321 -1.8 TD -0.0032 Tc -0.0434 Tw (House, J.S. \(1981\). )Tj /TT7 1 Tf 7.725 0 TD -0.0036 Tc -0.0453 Tw [(W)94.4(ork str)32.4(ess and social support. )]TJ /TT2 1 Tf 12.426 0 TD -0.0048 Tc 0 Tw (Reading,)Tj -18.951 -1.398 TD -0.004 Tc 0.072 Tw (MA: Addison-W)Tj 6.75 0 TD 0.0016 Tc 0 Tw [(esley)61.6(.)]TJ -7.95 -1.8 TD -0.0144 Tc -0.0616 Tw (Howard, J., & Rattien, S. \(2004\). )Tj /TT7 1 Tf 12.639 0 TD -0.0177 Tc 0 Tw (Forward)Tj /TT2 1 Tf 3.441 0 TD -0.0143 Tc -0.063 Tw [( \(pp.iii iv\). In B.A.)]TJ -14.88 -1.401 TD -0.006 Tc -0.0621 Tw [(Jackson, J.C. Baker)33(, M.S. Ridgely)63(, J.T)75(. Bartis, & H.I. Linn)]TJ T* -0.003 Tc 0 Tw (\(Eds.\), )Tj /TT7 1 Tf 2.94 0 TD -0.0044 Tc 0.0477 Tw [(P)5.6(r)31.6(otecting emer)31.6(gency r)28.6(esponders:)]TJ /TT2 1 Tf 13.689 0 TD 0 Tc 0 Tw ( )Tj /TT7 1 Tf 0.297 0 TD -0.002 Tc 0.0475 Tw [(V)113.8(ol. 3. )]TJ /TT2 1 Tf 2.853 0 TD 0 Tc 0 Tw ( )Tj /TT7 1 Tf 0.3 0 TD -0.0045 Tc (Safety)Tj -20.079 -1.398 TD -0.0013 Tc 0.125 Tw (management in disaster and terrorism)Tj /TT2 1 Tf 15.789 0 TD 0.122 Tc 0 Tw ( r)Tj /TT7 1 Tf 0.711 0 TD -0.0027 Tc (esponse)Tj /TT2 1 Tf 3.156 0 TD -0.0004 Tc 0.125 Tw (. Santa)Tj -19.656 -1.401 TD -0.0043 Tc 0.0192 Tw (Monica, CA: RAND Corp., MG-170-NIOSH, 2004. Re-)Tj T* -0.004 Tc 0.03 Tw [(trieved )50(August 5, 2006, from http://www)62(.rand.or)14(g/publi-)]TJ 0 -1.398 TD -0.0133 Tc 0 Tw (cations/MG/MG17)Tj -1.2 -1.8 TD -0.0077 Tc -0.061 Tw (Institute of Medicine \(Ed.\). \(2003\). )Tj /TT7 1 Tf 13.74 0 TD -0.0087 Tc -0.0634 Tw (Preparing for the psycho-)Tj -12.54 -1.401 TD -0.0037 Tc 0.0022 Tw (logical consequences of terrorism: A public health strat-)Tj T* -0.0069 Tc 0 Tw (egy)Tj /TT2 1 Tf 1.374 0 TD -0.0035 Tc 0.1251 Tw [(. )14.6(W)94.3(ashington, DC: Board on Neuroscience and Be-)]TJ -1.374 -1.398 TD -0.0131 Tc -0.0619 Tw [(havioral Health of the National )53.1(Academies, National )50.1(Acad-)]TJ 0 -1.401 TD -0.004 Tc -0.025 Tw (emies Press.)Tj -1.2 -1.8 TD -0.0116 Tc -0.0621 Tw [(Jackson, B.A., Baker)39.4(, J.C., Ridgely)63.4(, M.S., Bartis, J.T)72.4(., & Linn,)]TJ 1.2 -1.401 TD -0.0083 Tc -0.0617 Tw (H.I. \(Eds.\). \(2004\). )Tj /TT7 1 Tf 7.53 0 TD -0.01 Tc -0.0619 Tw [(P)6(r)29(otecting emer)29(gency r)29(esponders: V)107(ol.)]TJ -7.53 -1.398 TD -0.006 Tc -0.0614 Tw [(3. 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New )35.1(Y)103.1(ork: Guilford.)]TJ -4.209 -1.8 TD -0.0032 Tc 0.0006 Tw [(Levenson, R.L., & Dwyer)35.8(, L.A. \(2003\). Peer support in law)]TJ 1.2 -1.398 TD -0.0081 Tc -0.061 Tw (enforcement: Past, present, and future. )Tj /TT7 1 Tf 15.036 0 TD -0.0091 Tc -0.065 Tw (International Jour-)Tj -15.036 -1.401 TD -0.0038 Tc -0.048 Tw (nal of Emergency Mental Health, 5)Tj /TT2 1 Tf 13.746 0 TD -0.05 Tw [(\(3\), 147-152.)]TJ -14.946 -1.8 TD -0.0103 Tc -0.0622 Tw (Loo, R. \(1999\). Police suicide: The ultimate stress reaction. In)Tj 1.2 -1.401 TD -0.0032 Tc 0.0026 Tw [(J.M. )17.9(V)65(iolanti & D. Paton \(Eds.\), )]TJ /TT7 1 Tf 13.08 0 TD -0.0041 Tc 0.005 Tw (Police trauma: Psycho-)Tj -13.08 -1.398 TD -0.0149 Tc -0.062 Tw (logical aftermath of civilian combat )Tj /TT2 1 Tf 13.779 0 TD -0.0152 Tc -0.0625 Tw (\(pp. 241254\). Spring-)Tj -13.779 -1.401 TD -0.011 Tc (field, IL: Charles C Thomas.)Tj ET endstream endobj 176 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 178 0 obj << /Length 10598 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (37)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0038 Tc -0.0622 Tw [(Loo, R. \(2003\). )53.2(A)58.4( meta-analysis of police suicide rates: Find-)]TJ 1.2 -1.398 TD 0.0031 Tc 0.125 Tw (ings and issues. )Tj /TT7 1 Tf 6.936 0 TD 0.003 Tc [(Suicide and life-thr)33(eatening behavior)105(,)]TJ -6.936 -1.401 TD -0.031 Tc 0 Tw (33)Tj /TT2 1 Tf 0.954 0 TD -0.0216 Tc -0.06 Tw (, 313325.)Tj -2.154 -1.8 TD -0.014 Tc -0.0621 Tw [(Masi, D., )52.1(Altman, L., Benayon, C., Healy)61(, H., Jor)16(gensen, D.G)115(.,)]TJ 1.2 -1.401 TD -0.0033 Tc -0.0371 Tw (Kennish, R., et al. \(2002\). 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COP-2-COP)32.7( hotlines:)]TJ 1.2 -1.401 TD 0.0033 Tc 0.125 Tw (Programs to address the needs of first responders and)Tj T* -0.002 Tc (their families. )Tj /TT7 1 Tf 6.03 0 TD 0.1248 Tw [(Brief T)48.9(r)36.1(eatment and Crisis Intervention,)]TJ -6.03 -1.398 TD 0 Tc 0 Tw (6)Tj /TT2 1 Tf 0.471 0 TD -0.031 Tc -0.06 Tw (\(1\), 66-78.)Tj -1.671 -1.8 TD -0.0034 Tc 0.0255 Tw [(V)64.8(iolanti, J.M., & )50.5(Aron, F)77.6(.)0( \(1994\). Ranking police stressors.)]TJ /TT7 1 Tf 1.2 -1.401 TD -0.0043 Tc -0.045 Tw (Psychological Reports)Tj /TT2 1 Tf 8.895 0 TD 0.001 Tc 0 Tw (, )Tj /TT7 1 Tf 0.456 0 TD -0.01 Tc (75)Tj /TT2 1 Tf 0.99 0 TD -0.0036 Tc -0.05 Tw (\(2\), 824-30.)Tj -11.541 -1.8 TD -0.0033 Tc -0.0627 Tw [(W)94.5(essely)62.7(, S., & Deahl, M. \(2003\). Psychological debriefing is)]TJ 1.2 -1.401 TD -0.0031 Tc -0.06 Tw (a waste of time. )Tj /TT7 1 Tf 6.291 0 TD -0.0037 Tc -0.0618 Tw [(British Journal of Psychiatry)56.1(,)]TJ /TT2 1 Tf 11.538 0 TD 0 Tc 0 Tw ( )Tj /TT7 1 Tf 0.192 0 TD -0.0075 Tc (183)Tj /TT2 1 Tf 1.485 0 TD -0.0034 Tc -0.065 Tw (, 12-14.)Tj 4.794 13.701 TD -0.003 Tc 0.0439 Tw [(W)55.8(itt, H. \(2005, )54(April 18\). Jim Ramsey: )15(T)37.8(ragedy haunts the)]TJ 1.2 -1.401 TD -0.0101 Tc 0 Tw (heroes. )Tj /TT7 1 Tf 2.97 0 TD -0.0111 Tc -0.0636 Tw [(Chicago T)54.9(ribune. )]TJ /TT2 1 Tf 6.939 0 TD -0.0109 Tc -0.0624 Tw [(Retrieved )52.2(August 15, 2007, from)]TJ -9.909 -1.398 TD 0.0475 Tc 0 Tw [(http://www)62.5(.chicagotribune.com/news/specials/chi-)]TJ 0 -1.401 TD -0.032 Tc (0504180178apr18,1,240146.story)Tj -1.2 -1.8 TD -0.0033 Tc 0.0377 Tw [(W)94.5(oody)62.7(, R.H. \(2005\). )17.5(The police culture: Research implica-)]TJ 1.2 -1.401 TD -0.0009 Tc 0.125 Tw (tions for psychological services. )Tj /TT7 1 Tf 13.611 0 TD -0.002 Tc (Professional Psychol-)Tj -13.611 -1.398 TD -0.0038 Tc -0.06 Tw (ogy: Research and Practice,)Tj /TT2 1 Tf 11.106 0 TD -0.0037 Tc [( 36, 525-529.)]TJ -12.306 -1.8 TD -0.0032 Tc -0.0101 Tw [(W)94.6(oody)62.8(, R.H. \(2006\) Family interventions with law enforce-)]TJ 1.2 -1.401 TD -0.0038 Tc 0.029 Tw [(ment of)14.2(ficers. )]TJ /TT7 1 Tf 5.796 0 TD -0.0041 Tc 0.0312 Tw (American Journal of Family Therapy)Tj /TT2 1 Tf 14.928 0 TD -0.001 Tc 0 Tw (, )Tj /TT7 1 Tf 0.537 0 TD -0.01 Tc (34)Tj /TT2 1 Tf 0.99 0 TD 0 Tc (,)Tj -22.251 -1.401 TD -0.0513 Tc (95-103.)Tj /TT7 1 Tf 9 0 0 9 400.5 536.4 Tm -0.0047 Tc 0.0032 Tw (Manuscript Received: January 25, 2008)Tj 0.9167 -1.7767 TD -0.0048 Tc 0.0015 Tw (Revision Received: February 26, 2008)Tj 3.4167 -1.78 TD -0.0046 Tc -0.0222 Tw [(Accepted: )-22.2( February 28, 2008)]TJ /TT4 1 Tf 10 0 0 10 239.16 361.5 Tm 0.0486 Tc 0.335 Tw (Catalog #MIT5)Tj -0.03 0 TD (Catalog #MIT5)Tj 0.03 0.03 TD (Catalog #MIT5)Tj -0.03 0 TD (Catalog #MIT5)Tj 0.015 -0.015 TD (Catalog #MIT5)Tj 0.015 -1.116 TD 0.048 Tc 0.23 Tw (Paperback 186pp \(2007\))Tj -0.03 0 TD (Paperback 186pp \(2007\))Tj 0.03 0.03 TD (Paperback 186pp \(2007\))Tj -0.03 0 TD (Paperback 186pp \(2007\))Tj 0.015 -0.015 TD (Paperback 186pp \(2007\))Tj 0.015 -1.113 TD 0.0471 Tc 0.865 Tw (ISBN 1)Tj -0.03 0 TD (ISBN 1)Tj 0.03 0.03 TD (ISBN 1)Tj -0.03 0 TD (ISBN 1)Tj 0.015 -0.015 TD (ISBN 1)Tj 3.705 -0.015 TD 0.0481 Tc 0 Tw (3:9)Tj -0.03 0 TD (3:9)Tj 0.03 0.03 TD (3:9)Tj -0.03 0 TD (3:9)Tj 0.015 -0.015 TD (3:9)Tj 1.374 -0.015 TD 0.0473 Tc (78-1-88358)Tj -0.03 0 TD (78-1-88358)Tj 0.03 0.03 TD (78-1-88358)Tj -0.03 0 TD (78-1-88358)Tj 0.015 -0.015 TD (78-1-88358)Tj 5.109 -0.015 TD 0.0465 Tc (1-2)Tj -0.03 0 TD (1-2)Tj 0.03 0.03 TD (1-2)Tj -0.03 0 TD (1-2)Tj 0.015 -0.015 TD (1-2)Tj 1.44 -0.015 TD (4-4)Tj -0.03 0 TD (4-4)Tj 0.03 0.03 TD (4-4)Tj -0.03 0 TD (4-4)Tj 0.015 -0.015 TD (4-4)Tj /F7 1 Tf 11 0 0 11 239.01 322.65 Tm 0.0164 Tc ($30.00)Tj /TT3 1 Tf 14 0 0 14 239.01 306.66 Tm 0.0016 Tc 0.1375 Tw (Group Crisis Support)Tj 0 -1.0007 TD -0.0051 Tc 0.1143 Tw (Why it works)Tj 0 -1.0929 TD 0.0921 Tw (When & How to provide it)Tj /F22 1 Tf 12 0 0 12 239.01 263.34 Tm -0.0033 Tc -0.0514 Tw (Jeffrey T. Mitchell, PhD)Tj /F23 1 Tf 10 0 0 10 239.01 251.01 Tm -0.0018 Tc 0.1101 Tw (Group Crisis Support )Tj /F24 1 Tf 7.41 0 TD 0.095 Tw (is a straightforward, practical guidebook for anyone providing either)Tj -7.41 -1.2 TD -0.0035 Tc 0.0167 Tw [(crucial information or crisis support services to distressed groups. More than a hundred years)]TJ T* -0.0034 Tc -0.0046 Tw (of sound crisis intervention theory and positive-outcome research back up the guidelines in the)Tj T* -0.0048 Tc 0 Tw (book. )Tj /F23 1 Tf 2.109 0 TD -0.0036 Tc (Group Crisis Support)Tj /F24 1 Tf 6.819 0 TD -0.0034 Tc -0.0005 Tw ( provides valuable information for those recently trained as well as)Tj -8.928 -1.2 TD 0.0225 Tw [(the more experienced peer support personnel and crisis intervention professionals. It contains)]TJ T* -0.0033 Tc 0.0228 Tw (thoughtful crisis management strategies and well-referenced crisis intervention procedures for)Tj T* -0.0036 Tc 0.0631 Tw (both large and small groups that will undoubtedly enhance the group management skills of)Tj T* -0.0034 Tc 0.008 Tw (trained crisis support personnel. )Tj /F23 1 Tf 10.473 0 TD -0.0035 Tc 0.0117 Tw (Group Crisis Support )Tj /F24 1 Tf 7.077 0 TD -0.0033 Tc 0.0091 Tw [(is an invaluable tool for crisis response)]TJ -17.55 -1.2 TD 0.0011 Tc 0.095 Tw (teams in schools, businesses, church groups, emergency medical services, fire services, law)Tj T* -0.0035 Tc 0.0362 Tw [(enforcement organizations, and the military)71.5(.)]TJ ET q 381.45 148.1 9.05 -6.7 re W n /GS1 gs /Fm6 Do Q BT /TT11 1 Tf 30 0 0 30 145.5 426 Tm /GS1 gs -0.0054 Tc 0.0425 Tw (Exclusively from Chevron!)Tj 24 0 5.04 24 139.5 396 Tm -0.0042 Tc 0.0232 Tw [(A New Book by Jeffrey T. Mitchell)]TJ ET q 71.05 371 151.75 -232 re W n /Fm8 Do Q 0 0 0 0.2 k 0.99 w 1000 M 70.495 126.005 468.01 -49.01 re B* BT /TT3 1 Tf 11 0 0 11 147.39 110.49 Tm 0 0 0 1 k /GS2 gs -0.004 Tc 0.0359 Tw (Get your copy of this important new resource by ordering NOW!)Tj 2.4191 -1.0909 TD -0.0047 Tc 0.0197 Tw (Order by calling Chevron Publishing at 410-740-0065)Tj 3.2045 -1.0909 TD 0.0303 Tw (Order online at chevronpublishing.com)Tj ET /GS1 gs 54.495 455.505 491.51 -386.01 re S endstream endobj 183 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F7 22 0 R /F22 184 0 R /F23 185 0 R /F24 186 0 R /TT2 9 0 R /TT3 10 0 R /TT4 23 0 R /TT7 57 0 R /TT11 187 0 R >> /XObject << /Fm6 188 0 R /Fm8 189 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 191 0 obj << /Length 5812 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (39)Tj /TT3 1 Tf 7 0 0 7 124.41 726.66 Tm -0.0061 Tc 0.0226 Tw [(International Journal of Emergency Mental Health, Vol. 10, No. 1, pp. 39-48 2008 Chevron Publishing ISSN 1522-4821)]TJ /TT6 1 Tf 10 0 0 10 102.99 476.34 Tm -0.0041 Tc 0 Tw (Abstract: )Tj /TT7 1 Tf 4.101 0 TD -0.0036 Tc 0.11 Tw (Critical incident stress debriefing is a highly utilized and often debated form of post-trauma)Tj -4.101 -1.299 TD 0.0014 Tc 0.125 Tw [(exposure intervention. This article presents exploratory group process research that utilized a mixed)]TJ T* 0.0152 Tc [(method appr)33.2(oach and gr)30.2(oup pr)30.2(ocess r)33.2(esear)30.2(ch techniques. The ar)-5.8(ticle)123.2(s findings, the emer)30.2(gence of)]TJ 0 -1.302 TD 0.019 Tc (therapeutic factors, support that CISD group work does yield indicators consistent with support/)Tj 0 -1.299 TD -0.0036 Tc 0.0097 Tw (psychoeducation groups with a crisis theme. Further the events that trigger the intervention yield specific)Tj T* 0.0033 Tc 0.125 Tw (therapeutic factors. CISD group work may be better understood through established group research)Tj 0 -1.302 TD -0.0035 Tc 0.075 Tw [(patterns. [International Journal of Emergency Mental Health, 2008, 10\(1\), pp. 39-48].)]TJ /TT1 1 Tf 9 0 0 9 195.9 371.01 Tm -0.0056 Tc 0.025 Tw (Key words: )Tj /TT7 1 Tf 5.16 0 TD 0.0033 Tc 0.0277 Tw (CISD, process research, group work, therapeutic factors)Tj ET /GS1 gs 66 191.745 m 299.01 191.745 l S BT 9 0 0 9 66 174 Tm /GS2 gs 0.0005 Tc 0.1258 Tw [(Debra )11.3(A)21.3( Pender)107.2(, PhD, LCPC, NCC, )11.3(ACS, )14.6(Assistant Pr)40.5(ofessor)103.8(,)]TJ 0 -1.2233 TD 0.0263 Tc 0.125 Tw (Counseling, Adult and Higher Education, Northern Illinois)Tj 0 -1.22 TD -0.0048 Tc -0.0219 Tw [(University)48.5(, DeKalb, IL, is clinical dir)35.2(ector of the Southern Illinois)]TJ 0 -1.2233 TD 0.004 Tc 0.125 Tw (Critical Incident Stress Management team and member of the)Tj T* 0.0218 Tc 0.1254 Tw (Blackhawk CISM team. Karen K. Prichard, PhD, Associate)Tj 0 -1.22 TD -0.018 Tc -0.0617 Tw [(Pr)35.3(ofessor)105.3(, Educational Psychology and Special Education, Southern)]TJ 0 -1.2233 TD 0.0104 Tc 0.1254 Tw [(Illinois University)50.4(, Carbondale, IL, is a Gr)30.4(oup Fellow of the)]TJ T* 0.0226 Tc 0.1249 Tw [(Association for Specialists in Gr)32.6(oup W)85.9(ork. Cor)-7.4(r)41.8(espondence)]TJ 0 -1.22 TD -0.005 Tc 0.0362 Tw [(r)40.8(egar)31.7(ding this ar)-5(ticle may be dir)31.7(ected to Debra )15.1(A)15.8( Pender)108.3(, email:)]TJ 0 -1.2233 TD -0.0057 Tc 0 Tw (dpender@niu.edu.)Tj /F1 1 Tf 14 0 0 14 80.4 629.34 Tm 0.002 Tc 0.1374 Tw [(G)5.4(r)12.7(oup Pr)14.9(ocess Resear)17(c)7.3(h)0.3( and Emer)10.6(g)-12.7(ence of )94(Therapeutic F)17(actor)10.6(s in)]TJ 8.25 -1.1421 TD -0.0008 Tc 0.1381 Tw (Critical Incident Stress Debriefing)Tj /TT2 1 Tf 10 0 0 10 84.99 323.16 Tm 0.0121 Tc 0.125 Tw (Crisis intervention after mass violence and disaster)Tj -1.8 -1.401 TD -0.0033 Tc 0.1222 Tw (events has become an important effort in the recovery of)Tj T* -0.0034 Tc -0.04 Tw (humans impacted by traumatic stress. The toll on the human)Tj 0 -1.398 TD -0.0032 Tc 0.0245 Tw (psyche is a significant concern for all disciplines of mental)Tj 0 -1.401 TD -0.0033 Tc 0.005 Tw (health professions. Group crisis intervention, through vary-)Tj T* -0.0031 Tc 0.0625 Tw (ing protocols, is one key standard of care for victims. The)Tj 0 -1.398 TD 0 Tw (goal of this exploratory research is to investigate the poten-)Tj 0 -1.401 TD -0.0164 Tc -0.0622 Tw (tial effectiveness of Critical Incident Stress Debriefing \(CISD\))Tj T* -0.0032 Tc 0.0662 Tw [(by using group research methodology)59.8(.)]TJ 12 0 0 12 399.66 566.64 Tm -0.008 Tc -0.0604 Tw (Karen K Prichard)Tj 10 0 0 10 384.66 554.01 Tm 0.0016 Tc -0.0175 Tw (Southern Illinois University)Tj 12 0 0 12 148.74 566.64 Tm -0.0071 Tc -0.1083 Tw [(Debra A)55.1( )-48.9(Pender)]TJ 10 0 0 10 129.99 554.01 Tm 0.0017 Tc -0.055 Tw (Northern Illinois University)Tj 20.901 -23.085 TD -0.003 Tc -0.0087 Tw (The issue of CISD efficacy is intensely debated, under-)Tj -1.8 -1.401 TD 0.0089 Tw (scored by the importance of early intervention for those ex-)Tj T* -0.0033 Tc 0.0187 Tw (posed to extreme stressors, and clouded with uncertainty as)Tj 0 -1.398 TD -0.0034 Tc 0.0855 Tw (the results of efforts to capture the intervention in random)Tj 0 -1.401 TD -0.0032 Tc 0.0414 Tw (controlled trials have not yielded empirical support. Strate-)Tj T* -0.0033 Tc -0.0206 Tw (gies found in group process research methodology may pro-)Tj 0 -1.398 TD -0.0037 Tc 0.0428 Tw (vide a path to understanding the mechanism of change that)Tj 0 -1.401 TD -0.0034 Tc 0.06 Tw (may occur in CISD work. This article assessed therapeutic)Tj T* -0.0069 Tc -0.0622 Tw (factors identified in narrative reports and as selected by CISD)Tj 0 -1.398 TD -0.0016 Tc 0.125 Tw (participants, Critical Incident Stress Management \(CISM\))Tj 0 -1.401 TD -0.0036 Tc 0.0963 Tw (peer leaders, and CISM mental health facilitators and em-)Tj T* -0.0033 Tc 0.009 Tw (ployed multi-site, multi-incident data collection techniques.)Tj 0 -1.398 TD -0.0032 Tc 0.0835 Tw (The research intended to answer the call given by the Na-)Tj 0 -1.401 TD -0.0035 Tc -0.0118 Tw (tional Institute of Mental Health \(2002\) Consensus on Early)Tj T* -0.0062 Tc -0.0621 Tw (Intervention to develop scientifically valid research and tech-)Tj 0 -1.398 TD 0.0017 Tc 0.125 Tw (nological innovations to improve assessment, early inter-)Tj 0 -1.401 TD -0.0104 Tc -0.0622 Tw [(vention, and the treatment of people exposed to mass violence)]TJ T* -0.0035 Tc 0.105 Tw (and natural disasters.)Tj ET endstream endobj 192 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 194 0 obj << /Length 8871 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.1375 Tw [(40 )]TJ /TT3 1 Tf 2.34 0 TD -0.0049 Tc (Pender and Prichard CISD Process Research Therapeutic Factors)Tj /F1 1 Tf 11 0 0 11 54 723.99 Tm -0.0041 Tc 0.0238 Tw (The State of the Inquiry)Tj /TT7 1 Tf 0 -1.5136 TD 0.0156 Tc 0.1258 Tw [(The Sear)32(ch for Efficacy)]TJ /TT2 1 Tf 10 0 0 10 72 687.66 Tm -0.0033 Tc -0.0168 Tw (Efficacy-based research has led to findings both in sup-)Tj -1.8 -1.401 TD -0.0035 Tc -0.017 Tw (port and not in support of the intervention. Problems in con-)Tj T* -0.0122 Tc -0.0621 Tw (ducting methodological research on the effectiveness of CISD)Tj 0 -1.398 TD -0.0032 Tc -0.005 Tw (\(also referred to in some literature as psychological debrief-)Tj 0 -1.401 TD -0.0038 Tc -0.0085 Tw (ing or PD\) have led to two camps: protagonists of CISD/PD)Tj T* -0.018 Tc -0.0622 Tw [(interventions \(Deahl, Srinivasan, Jones, Neblett, & Jolly)60(, 2001;)]TJ 0 -1.398 TD -0.0201 Tc [(Everly & Boyle, 1999; Everly)63.9(, Flannery)60.9(, & Eyler)39.9(, 2002; Everly)63.9(,)]TJ 0 -1.401 TD -0.0212 Tc -0.0626 Tw [(Flannery)59.8(, & Mitchell, 2000; Hokanson & )14.7(W)52.6(irth, 2000; Mitchell)]TJ T* -0.0034 Tc 0.0104 Tw [(& Everly)59.6(, 2000; Robinson & Mitchell, 1993; )17.4(W)97.4(ee, Mills, &)]TJ 0 -1.398 TD -0.0035 Tc 0.0422 Tw [(Koelher)35.5(, 1999\) and critics warning of risk of harm in these)]TJ 0 -1.401 TD -0.0068 Tc -0.0622 Tw (processes \(Bisson, McFarlane, & Rose, 2000; Bledsoe, 2003;)Tj T* -0.0199 Tc -0.062 Tw [(Carlier)34.1(, )16.3(V)132.3(oerman, & Gersons, 2000; Gist & Devilly)64.1(, 2002; Gist,)]TJ 0 -1.398 TD -0.0025 Tc 0.125 Tw [(Lubin, & Redburn, 1998; Kenardy)63.5(, 1998; Kenardy)63.5(, 2000;)]TJ 0 -1.401 TD -0.0145 Tc -0.0622 Tw [(McNally)60.5(, Bryant, & Ehlers, 2003; Rose & Bisson, 1998; Rose,)]TJ T* -0.0253 Tc -0.0623 Tw [(Bisson, & )13.5(W)99.5(essely)64.7(, 2001; )13.5(V)117.9(an Emmerik, Kamphuis, Hulsbosch,)]TJ 0 -1.398 TD -0.0387 Tc (& Emmelkamp, 2002\).)Tj 1.8 -2.001 TD -0.0034 Tc 0.0979 Tw [(The National Institute of Mental Health)53.6(s Early Inter)14.6(-)]TJ -1.8 -1.401 TD -0.0036 Tc 0.0793 Tw (vention consensus cautions that the evidence in support of)Tj 0 -1.398 TD -0.0039 Tc -0.0308 Tw (CISD/CISM interventions is weak in that random controlled)Tj 0 -1.401 TD -0.0036 Tc 0.11 Tw (trial \(RCT\) studies have not shown strong support for the)Tj T* -0.0058 Tc -0.0621 Tw [(method/model \(NIMH, 2002\). Everly)54.2(s rebuttal in the appen-)]TJ 0 -1.398 TD -0.0035 Tc 0.1096 Tw (dix of the report noted that most of the RCT studies con-)Tj 0 -1.401 TD 0 Tc 0.125 Tw (ducted did not use a group intervention and have serious)Tj T* -0.0185 Tc -0.0621 Tw (methodological flaws \(e.g. assigning primary victim with more)Tj 0 -1.398 TD -0.0036 Tc 0.0043 Tw (serious injuries to the treatment group, providing individual)Tj 0 -1.401 TD -0.0037 Tc -0.0271 Tw (not group interventions, and providing services during acute)Tj T* -0.0035 Tc 0.0012 Tw (phase of the trauma before resolution work is appropriate\).)Tj 1.8 -1.998 TD 0.0814 Tw (The belief that quantitative research can capture com-)Tj -1.8 -1.401 TD 0.0002 Tc 0.125 Tw (plex interventions, such as a CISD or other interventions)Tj T* -0.0034 Tc 0.0875 Tw (within the CISM model, and then determine their efficacy)Tj 0 -1.398 TD 0.0125 Tc 0.125 Tw [(seems too simplistic and over)18.5(-reaching. )51.5(A)59.7( recent article)]TJ 0 -1.401 TD -0.003 Tc -0.0566 Tw (indentifying empirically based essential elements of psycho-)Tj T* -0.0038 Tc 0.1219 Tw (logical first aid begins with the acknowledgment that no)Tj 0 -1.398 TD 0.0034 Tc 0.125 Tw (evidence-based consensus has been reached supporting a)Tj 0 -1.401 TD -0.0095 Tc -0.0625 Tw (clear set of recommendations for interventions in the immedi-)Tj T* -0.0034 Tc 0.005 Tw (ate and mid-term post-trauma phases. Because it is unlikely)Tj 0 -1.398 TD -0.0035 Tc -0.0427 Tw (that there will be evidence from clinical trials \(Hobfoll et)Tj 0 -1.401 TD -0.01 Tc -0.0625 Tw [(al., 2007, p 283-284\). )20(W)54.8(ithin the opening paragraph, they cite)]TJ T* 0.0024 Tc 0.125 Tw (evidence that psychological debriefing is not effective in)Tj 0 -1.398 TD -0.0036 Tc -0.045 Tw (preventing PSTD and may be harmful.)Tj 1.8 -2.001 TD -0.0203 Tc -0.0621 Tw [(Several authors \(Deahl, 2000; Shalev)63.7(, 2000; )15.7(W)53.5(ilson, 1999;)]TJ -1.8 -1.401 TD -0.0039 Tc 0.09 Tw [(W)54.9(ilson & Sigman, 2000\) conclude that PD/CISD research)]TJ 0 -1.398 TD -0.0036 Tc -0.0061 Tw (needs to address the following components: the reasons it is)Tj 25.5 64.098 TD -0.0033 Tc 0.074 Tw (valuable; the beliefs that drive it; the forms it should take;)Tj 0 -1.398 TD -0.0032 Tc 0.0561 Tw [(and the processes that are relevant and for whom. Everly)50.8(s)]TJ 0 -1.401 TD -0.0033 Tc -0.0118 Tw (rebuttal to the NIMH consensus served as a key guide in his)Tj T* -0.0037 Tc 0.1066 Tw (emphasis upon looking to the group factors in CISD. The)Tj 0 -1.398 TD -0.0039 Tc 0.045 Tw (discussion now shifts to how methods of conducting group)Tj 0 -1.401 TD -0.0005 Tc 0.125 Tw (research may enhance the current depth of understanding)Tj T* -0.0039 Tc 0.0638 Tw (about the CISD group processes.)Tj /TT7 1 Tf 11 0 0 11 309 605.34 Tm 0.0135 Tc 0.1249 Tw [(G)6.6(r)32.6(oup Pr)32.6(ocess Resear)29.9(ch)]TJ /TT2 1 Tf 10 0 0 10 327 585.66 Tm -0.0036 Tc 0.0186 Tw (Recognition of the importance of therapeutic factors in)Tj -1.8 -1.401 TD 0.004 Tc 0.125 Tw (group work first appeared in the writings of Corsini and)Tj T* -0.0032 Tc -0.0381 Tw (Rosenberg \(1955\). Extensive study of both training and psy-)Tj 0 -1.398 TD -0.0034 Tc 0.0457 Tw [(chotherapy group participant responses to group events led)]TJ 0 -1.401 TD -0.0168 Tc -0.0624 Tw [(to the development of eleven therapeutic factors \(Y)100.2(alom, 1970,)]TJ T* -0.0089 Tc [(1995, )30.3(Y)104.3(alom & Lesick, 2005\). )18.3(These include universality)60.1(, im-)]TJ 0 -1.398 TD -0.0043 Tc -0.062 Tw (parting information, altruism, hope, corrective recapitulation)Tj 0 -1.401 TD -0.0031 Tc -0.0158 Tw (of primary family group, development of socialization tech-)Tj T* -0.0035 Tc -0.0116 Tw [(niques, imitative behavior)38.5(, interpersonal learning, group co-)]TJ 0 -1.398 TD -0.0034 Tc 0.07 Tw (hesiveness, catharsis, and existential factors.)Tj 1.8 -2.001 TD -0.0037 Tc 0.1169 Tw [(Y)103.5(alom)50.3(s therapeutic factors have been further catego-)]TJ -1.8 -1.401 TD -0.0096 Tc -0.0622 Tw (rized into three theoretical classes: cognitive thinking about)Tj 0 -1.398 TD -0.0033 Tc 0.115 Tw [(factors \(guidance, self-understanding, universality)62.7(, and vi-)]TJ 0 -1.401 TD -0.0038 Tc 0.0575 Tw (carious learning\), behavioral learning from doing factors)Tj T* -0.0034 Tc -0.0225 Tw (\(altruism, learning for interpersonal actions, and self-disclo-)Tj 0 -1.398 TD -0.0037 Tc 0.0666 Tw (sure\), and affective emotional expression factors \(accep-)Tj 0 -1.401 TD -0.0033 Tc 0.0857 Tw (tance, catharsis, and instillation of hope; Bloch, Reibstein,)Tj T* -0.0137 Tc -0.0625 Tw (Holroyd, & Themen, 1979\). Kivlighan and Holmes \(2004\) de-)Tj 0 -1.398 TD -0.0031 Tc 0.0456 Tw (veloped a typology of groups based on the therapeutic fac-)Tj 0 -1.401 TD -0.0036 Tc -0.0261 Tw (tors members of many varied forms of group work endorsed)Tj T* -0.0076 Tc -0.0625 Tw (as important. The analysis led to four distinct types of groups:)Tj 0 -1.398 TD -0.0031 Tc 0.125 Tw (affective insight, affective support, cognitive support, and)Tj 0 -1.401 TD -0.0036 Tc 0.0375 Tw (cognitive insight. The different dimensions were character-)Tj T* -0.0028 Tc 0.0934 Tw [(ized by type of expression, \(i.e., whether the group leader)]TJ 0 -1.398 TD 0.0003 Tc 0.125 Tw (emphasized affective or cognitive interventions\) and pur-)Tj 0 -1.401 TD -0.0035 Tc -0.0481 Tw (pose of the group [i.e., whether interventions were perceived)Tj T* -0.008 Tc -0.0625 Tw (as supportive/stabilizing \(psychoeducational\) or insight/chal-)Tj 0 -1.398 TD -0.0032 Tc 0.125 Tw (lenge to grow \(counseling/treatment\)]. Figure 1 illustrates)Tj 0 -1.401 TD -0.0028 Tc 0.0525 Tw [(the top therapeutic factors in the typology)60.2(.)]TJ 1.8 -2.001 TD 0.0061 Tc 0.125 Tw (Understanding the perceptions of therapeutic factors)Tj -1.8 -1.398 TD -0.0033 Tc 0.1249 Tw [(from both providers and participants in the CISD process)]TJ 0 -1.401 TD -0.0035 Tc -0.0581 Tw (and noting the similarities and differences in reported factors)Tj T* -0.0037 Tc -0.0625 Tw (may lead to clarification of why some find the groups helpful)Tj 0 -1.398 TD 0.0086 Tc 0.1249 Tw (and others do not. It has been proposed that therapeutic)Tj 0 -1.401 TD -0.0036 Tc -0.003 Tw (factors are present in CISD work but research has not docu-)Tj T* -0.0057 Tc -0.0625 Tw (mented which factors will emerge.)Tj ET endstream endobj 195 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 197 0 obj << /Length 6118 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (41)Tj 11 0 0 11 126.75 426 Tm 0.0098 Tc 0.1409 Tw (RESEARCH METHOD)Tj /TT2 1 Tf 10 0 0 10 84 402.66 Tm -0.0135 Tc -0.0621 Tw (This mixed model inquiry utilized web-based data collec-)Tj -1.8 -1.401 TD -0.002 Tc 0.125 Tw (tion of a structured interview with a purposive sample of)Tj T* -0.0036 Tc 0.0771 Tw (emergency service personnel and CISM mental health and)Tj 0 -1.398 TD 0.0489 Tw (peer providers to assess the group process factors and con-)Tj 0 -1.401 TD 0.0206 Tw [(textual factors in CISD interventions. This section outlines)]TJ T* -0.0003 Tc 0.125 Tw (the strategies for undertaking this study: selecting the re-)Tj 0 -1.398 TD -0.0033 Tc 0.0693 Tw (search paradigm and theoretical frame; identifying the pri-)Tj 0 -1.401 TD -0.0106 Tc -0.0625 Tw (mary research question; describing the methodological tactics)Tj T* 0.0066 Tc 0.125 Tw (for gathering the data; constructing the web-based ques-)Tj 0 -1.398 TD -0.0036 Tc -0.0125 Tw (tionnaires; selecting and recruiting informants; and utilizing)Tj 0 -1.401 TD -0.0038 Tc -0.0271 Tw [(purposive sampling via web-based recruitment. The section)]TJ T* -0.0033 Tc 0.0825 Tw (concludes with data analysis procedures.)Tj /F1 1 Tf 11 0 0 11 66 195.99 Tm -0.0048 Tc 0.05 Tw [(P)34.9(aradigm Selection and )93.4(Theoretical Frame)]TJ /TT7 1 Tf 10 0 0 10 84 172.65 Tm 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.225 0 TD -0.0038 Tc -0.0292 Tw (The selection of pragmatism as the guiding philosophi-)Tj -2.025 -1.401 TD -0.0044 Tc -0.0622 Tw (cal framework for the inquiry was consistent with the inquiry)Tj 0 -1.398 TD -0.0048 Tc (goals of understanding how CISD group effectiveness serves)Tj 0 -1.401 TD -0.0107 Tc (to mediate trauma resolution for emergency responders. Prag-)Tj T* -0.0034 Tc -0.0475 Tw (matically-based designs strive to integrate assumptions, data)Tj 0 -1.398 TD -0.0035 Tc (collection methods, and analytic techniques toward explana-)Tj 0 -1.401 TD -0.0031 Tc 0.1182 Tw (tions that not only distill the best of both worlds but also)Tj T* -0.0164 Tc -0.0625 Tw [(serve to more fully capture the studied phenomenon \(Creswell,)]TJ 25.5 35.1 TD -0.0054 Tc (1998\). While the mixed model design reflected the principles)Tj 0 -1.398 TD -0.0035 Tc 0.0375 Tw (of pragmatism, the final product, the understanding and re-)Tj 0 -1.401 TD -0.0038 Tc 0.1185 Tw (construction of knowledge coalesced from a consensus of)Tj T* 0.0595 Tc 0.271 Tw (personally defined experience, is underscored by)Tj 0 -1.398 TD -0.0036 Tc 0.0192 Tw [(constructivist values. Consensual qualitative research prin-)]TJ 0 -1.401 TD -0.0032 Tc 0.0716 Tw [(ciples served as a unifying qualitative model that allowed)]TJ T* -0.0035 Tc 0.0483 Tw (generation of theory of how the essence of trauma expo-)Tj 0 -1.398 TD 0.0183 Tw (sure and resolution either emerges or fails to emerge across)Tj 0 -1.401 TD -0.0037 Tc 0.0482 Tw (multiple case studies of CISD group process reviews \(Hill,)Tj T* -0.004 Tc -0.0131 Tw [(Thompson, & )17.5(W)54.8(illiams, 1997; Hill, Knox, )17.5(Thompson, )14.5(W)54.8(ill-)]TJ 0 -1.398 TD -0.0085 Tc -0.0625 Tw [(iams, Hess, & Ladany)63.5(, 2005\).)]TJ 1.8 -2.001 TD -0.0027 Tc 0.0772 Tw (The theoretical frame, or lens, for this type of inquiry)Tj -1.8 -1.401 TD -0.0033 Tc 0.0771 Tw (consisted of three primary perspectives that influenced the)Tj 0 -1.398 TD 0.0152 Tc 0.125 Tw (choices for data collection methods and the subsequent)Tj 0 -1.401 TD -0.0066 Tc -0.0625 Tw (analysis: current literature on CISM and CISD; current litera-)Tj T* -0.0038 Tc -0.0168 Tw (ture on trauma resolution; and methods of conducting group)Tj 0 -1.398 TD -0.0037 Tc -0.045 Tw (process/outcome research. The theoretical frame was further)Tj 0 -1.401 TD -0.0012 Tc 0.125 Tw (influenced by the personal lens of the primary researcher)Tj T* -0.0106 Tc -0.0622 Tw [(who is a CISD mental health provider and CISM trainer)37.4(, and a)]TJ 0 -1.398 TD -0.0136 Tc (practicing trauma counselor with familial connections to those)Tj 0 -1.401 TD -0.0043 Tc [(impacted by emergency services trauma exposure. Selection)]TJ T* -0.0034 Tc -0.0262 Tw (of the method of inquiry was congruent with the philosophi-)Tj 0 -1.398 TD -0.0129 Tc -0.0621 Tw (cal assumptions of pragmatism. The chosen methods reflected)Tj 0 -1.401 TD -0.0034 Tc 0.045 Tw (the three theoretical fields and accounted for researcher in-)Tj T* -0.0061 Tc 0 Tw (fluence.)Tj ET 2.01 w 1000 M /GS1 gs 68.005 697.995 490.99 -225.99 re S BT /F19 1 Tf 10 0 2.1256 10 78.9 723.99 Tm /GS2 gs -0.005 Tc -0.015 Tw (Figure 1.)Tj /TT3 1 Tf 10 0 0 10 117.81 723.99 Tm -0.0047 Tc -0.0186 Tw [( Kilvighan and Holmes \(2004\) Affective/cognitive and support/insight typology of therapeutic factors)]TJ 15.234 -1.2 TD -0.0051 Tc -0.0633 Tw (found in group work.)Tj /TT2 1 Tf 12 0 0 12 153.9 679.65 Tm -0.0295 Tc -0.0625 Tw (Affective Suport)Tj 10 0 0 10 167.01 656.64 Tm 0.0152 Tc 0 Tw (Acceptance)Tj 1.314 -1.098 TD 0.003 Tc (Hope)Tj -1.35 -1.101 TD -0.0062 Tc (Universality)Tj ET 10 M /GS1 gs 66.99 584.505 m 560.01 584.505 l 313.995 699 m 313.995 473.01 l S BT 12 0 0 12 397.5 526.65 Tm /GS2 gs -0.0412 Tc -0.0625 Tw (Cognitive Insight)Tj 10 0 0 10 396 503.64 Tm -0.0019 Tc 0 Tw (Self-Understanding)Tj 0.189 -1.098 TD -0.0116 Tc -0.06 Tw [(V)65.6(icarious Learning)]TJ 12 0 0 12 151.74 526.65 Tm -0.0283 Tc -0.0625 Tw (Cognitive Suport)Tj 10 0 0 10 152.91 503.64 Tm -0.0116 Tc -0.06 Tw [(V)65.6(icarious Learning)]TJ 1.833 -1.098 TD 0 Tw (Guidance)Tj 12 0 0 12 399.66 677.64 Tm -0.0424 Tc -0.0625 Tw (Affective Insight)Tj 10 0 0 10 411.99 654.66 Tm 0.0152 Tc 0 Tw (Acceptance)Tj 0.525 -1.101 TD 0.0035 Tc (Catharsis)Tj -2.025 -1.101 TD -0.0019 Tc (Self-Understanding)Tj ET 0 0 0 0.3 k /GS1 gs 198 617 230.5 -64 re f BT 12 0 0 12 208.89 589.65 Tm 0 0 0 1 k /GS2 gs -0.0129 Tc -0.0613 Tw [(T)72.9(ype of Expression and Purpose of the Group)]TJ 4.875 -1.1675 TD -0.0191 Tc -0.0625 Tw (Therapeutic Factors)Tj ET endstream endobj 198 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F19 67 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 200 0 obj << /Length 8263 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.1375 Tw [(42 )]TJ /TT3 1 Tf 2.34 0 TD -0.0049 Tc (Pender and Prichard CISD Process Research Therapeutic Factors)Tj /TT2 1 Tf 10 0 0 10 72 722.64 Tm -0.0036 Tc 0.0244 Tw (The primary focus of using a mixed method \(emphasis)Tj -1.8 -1.398 TD -0.0037 Tc 0.04 Tw (on qualitative\) approach to further understanding the CISD)Tj 0 -1.401 TD -0.0035 Tc 0.105 Tw [(process is further supported by Patton)50.5(s \(2002\) support of)]TJ T* -0.0032 Tc 0.125 Tw (qualitative approaches:)Tj /TT7 1 Tf 2.1 -1.998 TD -0.004 Tc 0.022 Tw [(\(a\) depicting process requires detailed descrip-)]TJ 0 -1.401 TD -0.0036 Tc 0.125 Tw (tions of how people engage each other; \(b\) the)Tj T* 0.0758 Tw (experience of process typically varies for differ-)Tj 0 -1.398 TD 0.1113 Tw (ent people so their experience needs to be cap-)Tj 0 -1.401 TD -0.0037 Tc 0.005 Tw (tured in their own words; \(c\) process is fluid and)Tj T* 0.0063 Tc 0.1249 Tw [(dynamic so it can)105.3(t be fairly summarized on a)]TJ 0 -1.398 TD -0.0036 Tc 0.0844 Tw (single rating scale at one point in time; and \(d\))Tj 0 -1.401 TD -0.0037 Tc 0.0575 Tw (participants perceptions are a key process con-)Tj T* -0.0026 Tc 0.125 Tw (sideration \(p. 159\).)Tj /TT2 1 Tf -0.3 -1.998 TD -0.0002 Tc [(In summary)59.8(, the rationale for the inquiry design was)]TJ -1.8 -1.401 TD -0.0037 Tc 0.0007 Tw (based upon the philosophical approach of practical explora-)Tj T* -0.0091 Tc -0.0625 Tw [(tion of the CISD utilizing process research. More specifically)59.9(,)]TJ 0 -1.398 TD -0.0034 Tc 0.0587 Tw (this research effort used principles set forth for conducting)Tj 0 -1.401 TD -0.0038 Tc 0 Tw (group process research \(Burlingame, Fuhriman, & Johnson,)Tj T* -0.0349 Tc -0.0622 Tw [(2004; DeLucia-W)76.1(aack, 1997; DeLucia-W)73.1(aack & Bridford, 2004\))]TJ 0 -1.398 TD -0.0049 Tc -0.0625 Tw (and principles that were consistent with the contextual model)Tj 0 -1.401 TD 0.0022 Tc 0.125 Tw (of finding effectiveness in psychotherapy and counseling)Tj T* -0.004 Tc 0.0143 Tw [(\(Ahn & )17(W)93.8(ampold, 2001; )17(W)93.8(ampold, 2001\). Ef)17(fectiveness of)]TJ 0 -1.398 TD -0.0034 Tc 0.045 Tw (the CISD process may be better understood in terms of the)Tj 0 -1.401 TD -0.0037 Tc -0.0623 Tw [(mechanisms of change \(i.e. therapeutic factors\) that occur)38.3(, or)]TJ T* -0.0038 Tc 0.1027 Tw [(do not occur)50.2(.)-7( )17.1(This data can be provided through intensive)]TJ 0 -1.398 TD -0.0033 Tc -0.0506 Tw (analysis of the narrative accounts of those that provide CISD)Tj 0 -1.401 TD -0.0034 Tc -0.0093 Tw (interventions and the emergency responders that receive the)Tj T* 0.0015 Tc 0 Tw (intervention.)Tj /F1 1 Tf 11 0 0 11 54 300 Tm -0.0049 Tc 0.0666 Tw (Research Question and Questionnaire)Tj 0 -1.0909 TD 0.0014 Tc 0 Tw (Design)Tj /TT2 1 Tf 10 0 0 10 72 264.66 Tm -0.0035 Tc 0.0083 Tw (The participant in the research was the CISD, that is,)Tj -1.8 -1.401 TD -0.0026 Tc 0.1249 Tw [(the report about the debriefing itself. )15.3(W)98.2(e)0.3( considered each)]TJ T* -0.0027 Tc -0.005 Tw (CISD report in totality as we analyzed the data. Three types)Tj 0 -1.398 TD -0.0108 Tc -0.0622 Tw (of informants were recruited for participation: emergency ser-)Tj 0 -1.401 TD -0.0036 Tc 0.035 Tw (vices personnel, CISM peers \(emergency service personnel)Tj T* -0.0038 Tc -0.0275 Tw (trained in CISD protocols\), and CISM mental health provid-)Tj 0 -1.398 TD -0.0036 Tc 0.0326 Tw [(ers \(Master)-39.6()56.4(s)-0.2( level and above practitioners\). Each of)14.4(fered a)]TJ 0 -1.401 TD 0.0977 Tw (different view of the CISD group process and the conver-)Tj T* 0.0165 Tc 0.125 Tw (gence/divergence of these viewpoints was used in both)Tj 0 -1.398 TD -0.0031 Tc 0.0308 Tw (analysis of data and interpretation of findings.)Tj 1.8 -2.001 TD -0.0036 Tc -0.0067 Tw (The question was as follows: )Tj /TT7 1 Tf 11.964 0 TD -0.004 Tc -0.0075 Tw (What can we learn about)Tj -13.764 -1.401 TD -0.0039 Tc 0.0608 Tw (CISD effectiveness by examining the potential mechanisms)Tj 0 -1.398 TD -0.0045 Tc 0.125 Tw (of change?)Tj /TT2 1 Tf 27.3 63.198 TD -0.0037 Tc 0.0264 Tw (The selection of items in the web-based questionnaires)Tj -1.8 -1.398 TD -0.0038 Tc 0.07 Tw (reflected established methods and procedure in conducting)Tj 0 -1.401 TD 0.0649 Tw [(group process/outcome effectiveness research \(Burlingame)]TJ T* -0.0035 Tc 0.0111 Tw [(et al., 2004\). The core focus, CISD group process/outcome)]TJ 0 -1.398 TD 0.0333 Tw (research, has clear foundations in the seminal works on the)Tj 0 -1.401 TD 0.0741 Tw (effectiveness of groups. Therapeutic factor research devel-)Tj T* -0.0057 Tw (oped through two distinct methods, the Q-sort methodology)Tj 0 -1.398 TD -0.0105 Tc -0.0621 Tw (that employs group member ranking of descriptive statements)Tj 0 -1.401 TD -0.0039 Tc 0.0905 Tw [(about the group experience \(Y)95.1(alom, 1970, 1995, )32(Y)103.3(alom &)]TJ T* -0.0035 Tc 0.0314 Tw (Lesick, 2005\), and the critical incident questionnaire \(CIQ\))Tj 0 -1.398 TD -0.0069 Tc -0.0621 Tw (methodology that employs rater coding of members answers)Tj 0 -1.401 TD -0.0047 Tc (to open-ended questions about their group experience \(Bloch)Tj T* -0.0033 Tc 0.0894 Tw (et al, 1979\). Using both a ranking system and open-ended)Tj 0 -1.398 TD -0.0037 Tc 0.0478 Tw (questions in the web-based questionnaire allowed for cross)Tj 0 -1.401 TD -0.003 Tc -0.0625 Tw (checking the veracity of the narrative, as a source of verifica-)Tj T* -0.0033 Tc -0.0432 Tw (tion for the raters, and served to allow a direct comparison to)Tj 0 -1.398 TD 0.0038 Tc 0.125 Tw (the aforementioned expression/purpose therapeutic factor)Tj 0 -1.401 TD 0.0106 Tc 0 Tw [(typology)64.6(.)]TJ 1.8 -2.001 TD -0.0033 Tc 0.0078 Tw (There were a series of studies utilizing the critical inci-)Tj -1.8 -1.398 TD -0.0036 Tc -0.0118 Tw (dent questionnaire \(CIQ\) in group work methodology to de-)Tj 0 -1.401 TD -0.0105 Tc -0.0621 Tw (velop frameworks to explain helpful moments, group climate,)Tj T* -0.002 Tc 0.125 Tw (damaging aspects, leader effectiveness, member contribu-)Tj 0 -1.398 TD 0.0143 Tc (tion, and group cohesion \(Kivlighan & Goldfine, 1991;)Tj 0 -1.401 TD 0.0059 Tc (Kivlighan & Holmes, 2004; Kivlighan & Jauquet, 1990;)Tj T* -0.0039 Tc -0.0129 Tw (Kivlighan, Multon, & Brussant, 1996; Smokowski, Rose, &)Tj 0 -1.398 TD -0.0134 Tc -0.0625 Tw (Bacallo, 2001; Wheeler & Kivlighan, 1995\). Each employed a)Tj 0 -1.401 TD -0.0037 Tc 0.1186 Tw (different version of open-ended questions focusing on the)Tj T* -0.0036 Tc -0.0272 Tw (particular aspect being sought. Replication of these methods)Tj 0 -1.398 TD 0.0794 Tw (within the current design allowed for direct comparison to)Tj 0 -1.401 TD -0.0033 Tc 0.0928 Tw (existing group research during the analysis and interpreta-)Tj T* 0.0175 Tw (tion of data.)Tj 1.8 -1.998 TD -0.0035 Tc 0.0516 Tw (The web-based questionnaires for each informant type)Tj -1.8 -1.401 TD -0.04 Tw (gathered data about the experience of the CISD process. The)Tj T* -0.025 Tw (questionnaire used CIQ style questions asking informants to)Tj 0 -1.398 TD -0.0037 Tc -0.0343 Tw [(identify the important aspects \(helpful moments\), )10.9(What did)]TJ 0 -1.401 TD -0.0034 Tc 0.0717 Tw (you see as the most important aspects or discussion points)Tj T* -0.0035 Tc 0.1171 Tw (that happened during the debriefing? and distressful mo-)Tj 0 -1.398 TD -0.0262 Tw (ments \(leader failures or challenges to the protocol\), Please)Tj 0 -1.401 TD 0.0209 Tc 0.125 Tw (describe any stressful or upsetting moments/discussion)Tj T* -0.0037 Tc 0.0639 Tw (points during the CISD. What happened? This part of the)Tj 0 -1.398 TD 0.0114 Tc 0.125 Tw (questionnaire concluded with a therapeutic factor rating)Tj 0 -1.401 TD 0.0026 Tc (scale. Basic demographics and work/training experiences)Tj T* -0.0035 Tc -0.06 Tw (were collected as well.)Tj 1.8 -1.998 TD 0.0036 Tc 0.125 Tw (The final aspect of the questionnaire design was the)Tj -1.8 -1.401 TD -0.0037 Tc -0.0071 Tw (decision to adopt computer-mediated collection as a vehicle)Tj T* -0.0035 Tc 0.0314 Tw (for contacting respondents and collecting, storing, and ana-)Tj ET endstream endobj 201 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 203 0 obj << /Length 8217 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (43)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0034 Tc -0.0292 Tw (lyzing the data. Computer-mediated research offered the ad-)Tj 0 -1.398 TD -0.003 Tc 0.0206 Tw (vantage of increasing the diversity and heterogeneity of the)Tj 0 -1.401 TD -0.0033 Tc -0.0195 Tw (sample \(Mann & Stewart, 2000\) as well as the types of indi-)Tj T* -0.0077 Tc -0.0621 Tw (vidual experiences, events, quality of the CISD interventions,)Tj 0 -1.398 TD -0.0032 Tc 0.01 Tw (and the variety of outcomes. Emergency responders as well)Tj 0 -1.401 TD -0.0035 Tc 0.0638 Tw (as many mental health providers have access to computers)Tj T* -0.0031 Tc 0.0004 Tw (and use them as a routine part of daily work activities. Both)Tj 0 -1.398 TD -0.0036 Tc 0.04 Tw (mental health providers and emergency response personnel)Tj 0 -1.401 TD -0.0034 Tc -0.0105 Tw (are accustomed to case notes that deal with a record of what)Tj T* -0.0037 Tc 0.0008 Tw (happened within bounds of protecting sensitive client infor-)Tj 0 -1.398 TD -0.0034 Tc -0.0356 Tw (mation. Thus both groups would have a familiarity with nar-)Tj 0 -1.401 TD -0.0088 Tc -0.0625 Tw (rative reporting \(Mann & Stewart, 2000\). The study protocols)Tj T* -0.0146 Tc (were reviewed by the Southern Illinois University-Carbondale)Tj 0 -1.398 TD -0.0039 Tc 0.0381 Tw (Human Subjects Committee and found to be appropriate to)Tj 0 -1.401 TD -0.0036 Tc 0.0275 Tw [(commence the study)59.4(.)]TJ /F1 1 Tf 11 0 0 11 66 494.01 Tm -0.0047 Tc 0.0728 Tw (Informants and Recruitment)Tj /TT2 1 Tf 10 0 0 10 84 470.64 Tm -0.0036 Tc 0.1158 Tw (Emergency services personnel and CISD service pro-)Tj -1.8 -1.398 TD -0.0494 Tw (viders, both mental health and peers, who had participated in)Tj 0 -1.401 TD 0.0427 Tw [(the CISD process within the last six months were recruited)]TJ T* -0.0038 Tc -0.0464 Tw (through the membership email services of professional asso-)Tj 0 -1.398 TD -0.0034 Tc -0.0514 Tw (ciations \(e.g., the International Critical Incident Stress Foun-)Tj 0 -1.401 TD -0.0094 Tc -0.0625 Tw (dation, the CISM Coordinators list serve, the Illinois Network)Tj T* -0.0038 Tc 0.0672 Tw [(of Critical Incident S)17.2(tress Management )17.3(T)70(e)0(ams, the Central)]TJ 0 -1.398 TD -0.0115 Tc -0.0622 Tw (Illinois Fire Fighters Union, and the Illinois Fraternal Order of)Tj 0 -1.401 TD -0.0035 Tc 0.0273 Tw (Police\). Recruitment letters were sent in the form of emails)Tj T* -0.0032 Tc 0.0065 Tw (and provided a hypertext link to the appropriate form of the)Tj 0 -1.398 TD -0.003 Tc 0.0089 Tw (questionnaire as well as a paper flyer version distributed by)Tj 0 -1.401 TD -0.0038 Tc -0.0412 Tw [(participating CISM teams. )53.3(As CISM teams agreed to partici-)]TJ T* -0.0031 Tc -0.0204 Tw (pate, they in turn were asked to forward the link to the ques-)Tj 0 -1.398 TD -0.0034 Tc -0.0172 Tw (tionnaire for emergency service response personnel that had)Tj 0 -1.401 TD -0.0035 Tc 0.0828 Tw (received services. Recruitment continued until the data set)Tj T* -0.0032 Tc -0.0567 Tw (reflected a variety of CISD reports that represented the range)Tj 0 -1.398 TD -0.0033 Tc 0.011 Tw (and scope of typical CISD groups.)Tj /F1 1 Tf 11 0 0 11 66 213.99 Tm -0.0052 Tc 0.05 Tw (Data Analysis)Tj /TT2 1 Tf 10 0 0 10 84 190.65 Tm -0.0625 Tw (Consensual Qualitative Research \(CQR\) method \(Hill et)Tj -1.8 -1.401 TD -0.0033 Tc -0.0486 Tw [(al., 2005; Hill &)6.2( )18.4(W)55.5(illiams, 1997\) was selected for coding the)]TJ 0 -1.398 TD -0.0043 Tc -0.0621 Tw (transcripts. The CQR method allows for multiple researchers)Tj 0 -1.401 TD -0.0031 Tc 0.1089 Tw [(to create a strategy)62.9(, code the records, use consensus deci-)]TJ T* -0.0024 Tc 0.125 Tw (sion-making, and complete systematic examination of the)Tj 0 -1.398 TD -0.0035 Tc -0.0137 Tw (data. The research team consisted of the principal investiga-)Tj 0 -1.401 TD -0.0034 Tc 0.0678 Tw [(tor and two professionally licensed, master)-39.4()53.6(s)0.5( level counse-)]TJ T* 0.028 Tc 0.125 Tw (lors. The auditor during the consensus meetings is an)Tj 0 -1.398 TD -0.0038 Tc 0.063 Tw [(Association for Specialist in Group )14.1(W)97(ork Fellow)62.2(. )50.1(All were)]TJ 25.5 64.398 TD 0.1069 Tw (advanced group work supervisors and had been trained in)Tj 0 -1.398 TD -0.0037 Tc -0.061 Tw (the group CISM model. The use of an auditor enhances trust-)Tj 0 -1.401 TD -0.0033 Tc -0.055 Tw (worthiness of the data \(Hill et al, 2005\).)Tj 1.8 -2.001 TD -0.0036 Tc -0.0106 Tw (The team met on multiple occasions to create a consen-)Tj -1.8 -1.398 TD -0.0505 Tw (sus on the kinds of information that was emerging in the data)Tj 0 -1.401 TD 0.0159 Tw [(and how we might begin to interpret the themes. )14.4(W)97.3(e)0.2( identi-)]TJ T* -0.0033 Tc -0.0138 Tw [(fied textual data that yielded an understanding of the impor-)]TJ 0 -1.398 TD -0.0032 Tc -0.0569 Tw [(tance of therapeutic factors. The team identified consistency)]TJ 0 -1.401 TD -0.0036 Tc -0.0307 Tw (between the endorsement of therapeutic factors rating scales)Tj T* 0.105 Tw (and the narrative responses.)Tj /F1 1 Tf 11 0 0 11 412.5 558 Tm 0.0187 Tc 0 Tw (FINDINGS)Tj /TT2 1 Tf 10 0 0 10 339 534.66 Tm -0.0071 Tc -0.0625 Tw (The consensual qualitative research \(CQR\) derived find-)Tj -1.8 -1.401 TD -0.0031 Tc -0.0045 Tw (ings from the cross analysis of 38 critical incident stress de-)Tj T* 0.019 Tc 0.125 Tw (briefing \(CISD\) reports reflects 8 reports submitted by)Tj 0 -1.398 TD -0.0031 Tc 0.0393 Tw (emergency service responders \(ESR\), 14 reports by critical)Tj 0 -1.401 TD -0.0035 Tc -0.0431 Tw (incident stress management \(CISM\) peers, and 16 reports by)Tj T* -0.0055 Tc -0.0622 Tw (CISM mental health \(MH\) providers. Each informant sample)Tj 0 -1.398 TD -0.0036 Tc -0.0183 Tw (size is consistent with the recommended 8 to 15 participants)Tj 0 -1.401 TD -0.0137 Tc -0.0624 Tw [(\(Hill et al., 2005; Hill & )16.4(W)54.1(illiams, 1997\) and the methodologi-)]TJ T* 0.0013 Tc 0.125 Tw (cal requirement that participants be knowledgeable about)Tj 0 -1.398 TD -0.0037 Tc 0.1083 Tw [(the phenomenon under study)59.3(.)]TJ 1.8 -2.001 TD -0.0032 Tc 0.0045 Tw (The presentation of data in a CQR study is given in the)Tj -1.8 -1.401 TD 0.0839 Tw (third person rhetoric and uses certain terms to convey fre-)Tj 0 -1.398 TD -0.0111 Tc -0.0625 Tw (quency \(Hill et al, 2005\).)Tj /F1 1 Tf 11 0 0 11 321 327.99 Tm -0.0047 Tc 0.0197 Tw (Analysis of the Sample)Tj /TT2 1 Tf 10 0 0 10 339 304.65 Tm -0.0036 Tc 0.05 Tw (Basic details regarding the CIS event offered informa-)Tj -1.8 -1.401 TD 0.0073 Tc 0.125 Tw (tion about the necessity of conducting a CISD based on)Tj 0 -1.398 TD -0.0033 Tc -0.021 Tw (nature of the event and emergence of need in the emergency)Tj 0 -1.401 TD -0.0064 Tc -0.0622 Tw [(responders. In order to establish the applicability of the group)]TJ T* -0.0093 Tc -0.0625 Tw [(process data to follow)65.7(, it was important to determine the kinds)]TJ 0 -1.398 TD -0.0034 Tc -0.0344 Tw (of incidents that were reported, whether the reports reflected)Tj 0 -1.401 TD -0.0059 Tc -0.0621 Tw (significant incidents, and whether stress reactions were noted)Tj T* -0.0033 Tc -0.05 Tw (in the initial aftermath. Each of the reports included here met)Tj 0 -1.398 TD -0.0036 Tc 0.0137 Tw (those criteria. The CISD reports included incidents from 15)Tj 0 -1.401 TD -0.0034 Tc -0.0494 Tw (different states, as well Canada. There was an equal distribu-)Tj T* -0.0032 Tc 0.0995 Tw [(tion of reports from rural, suburban, small city)62.8(, and urban)]TJ 0 -1.398 TD -0.0049 Tc -0.0622 Tw (areas. Gender distribution for the informants was 18 men and)Tj 0 -1.401 TD -0.023 Tc -0.06 Tw (14 women.)Tj 1.8 -2.001 TD -0.0036 Tc 0.095 Tw (The ESR informants presented fire service, fire/emer-)Tj -1.8 -1.398 TD -0.0034 Tc -0.0625 Tw (gency medical services, emergency medical services \(EMS\),)Tj 0 -1.401 TD -0.0039 Tc 0.023 Tw (telecommunications, and law enforcement occupations. Six)Tj T* -0.0035 Tc -0.0322 Tw (of the ESR informants held two or more emergency services)Tj ET endstream endobj 204 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 206 0 obj << /Length 8861 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.1375 Tw [(44 )]TJ /TT3 1 Tf 2.34 0 TD -0.0049 Tc (Pender and Prichard CISD Process Research Therapeutic Factors)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0052 Tc -0.0622 Tw [(occupations \(e.g., full time in a sherif)18.8(f)-56.2()51.8(s department and part-)]TJ 0 -1.398 TD -0.0037 Tc 0.1007 Tw [(time or volunteer in both fire and EMS\). )50.4(All occupational)]TJ 0 -1.401 TD -0.0034 Tc 0.0825 Tw (statuses of full-time, part-time, paid-on-call, and volunteer)Tj T* -0.003 Tc 0.125 Tw (were represented. The years of emergency service ranged)Tj 0 -1.398 TD -0.0031 Tc -0.0625 Tw (from 5 to 29 years.)Tj 1.8 -2.001 TD -0.0106 Tc (The CISM Peers and Mental Health informants had com-)Tj -1.8 -1.401 TD -0.0037 Tc 0.0725 Tw (pleted the ICISF Group Intervention course and in general)Tj 0 -1.398 TD 0.0206 Tw (had completed two to three additional ICISF courses. Peers)Tj 0 -1.401 TD -0.0035 Tc 0.0583 Tw (generally reported having experienced multiple CIS events)Tj T* -0.0033 Tc 0.0257 Tw (within their own careers. Mental health providers generally)Tj 0 -1.398 TD -0.0037 Tc 0.0608 Tw (reported training backgrounds that included trauma assess-)Tj 0 -1.401 TD -0.0094 Tc -0.0622 Tw [(ment, intervention, and group work. )50.6(All providers in the study)]TJ T* -0.0038 Tc -0.035 Tw (met the protocols for selection of CISM team members.)Tj /F1 1 Tf 11 0 0 11 54 516 Tm -0.0064 Tc 0.054 Tw [(Emer)7.2(g)-9(ence of )96.2(Themes)]TJ /TT2 1 Tf 10 0 0 10 72 492.66 Tm -0.0036 Tc 0.0343 Tw (The CIQ responses and therapeutic factor rating scales)Tj -1.8 -1.401 TD -0.003 Tc 0.0314 Tw (yielded indications of key therapeutic factors. The research)Tj T* -0.0034 Tc -0.0429 Tw (team identified multiple therapeutic factors in the narratives.)Tj 0 -1.398 TD -0.0037 Tc -0.0308 Tw (The prominent narrative themes revealed therapeutic factors)Tj 0 -1.401 TD -0.0031 Tc 0.0327 Tw [(of universality)59.9(, acceptance, catharsis, and expression. Nar)17.9(-)]TJ T* -0.003 Tc 0.0207 Tw (ratives that reflected universality included a response by an)Tj 0 -1.398 TD -0.0036 Tc 0.0065 Tw (emergency responder who identified the most important as-)Tj 0 -1.401 TD -0.0039 Tc -0.0625 Tw (pect of the CISD, that what I was feeling was normal - that)Tj T* -0.0033 Tc 0.0722 Tw (others felt the way I did. Others responders concurred. I)Tj 0 -1.398 TD -0.0029 Tc -0.0109 Tw (wasnt alone. It brought us all together in a way that anyone)Tj 0 -1.401 TD -0.0037 Tc 0.0515 Tw (who hasnt experienced a debriefing can never understand.)Tj T* -0.005 Tc -0.0625 Tw (It was truly a wonderful experience. It made the pain external)Tj 0 -1.398 TD -0.0034 Tc 0.0211 Tw [(and not internal anymore. )-5.3(It is good to discover that I am)]TJ 0 -1.401 TD -0.0035 Tc 0.0761 Tw [(having normal responses to an abnormal situation. I learn)]TJ T* -0.0033 Tc -0.0327 Tw [(this from those I work with at the debriefing. None of us are)]TJ 0 -1.398 TD -0.0034 Tc -0.0093 Tw (bullet-proof and we are affected differently depending upon)Tj 0 -1.401 TD -0.0232 Tw [(our experiences and involvement. I believe it has to do with)]TJ T* -0.0031 Tc 0.0862 Tw [(where we are at personally as well. )33(Y)104.1(et another reported,)]TJ 0 -1.398 TD -0.034 Tw [(Everyone is reluctant to discuss personal affects. It is help-)]TJ 0 -1.401 TD -0.003 Tc 0.0319 Tw (ful to hear they are normal and judging by the responses in)Tj T* -0.0032 Tc 0.0115 Tw (the room, I am not alone. These themes were generally re-)Tj 0 -1.398 TD -0.0033 Tc -0.0119 Tw (ported by mental health and CISM peers as well.)Tj 1.8 -2.001 TD -0.0026 Tc 0.1251 Tw [(Acceptance emer)12.4(ged as a thematic therapeutic factor)51.4(.)]TJ -1.8 -1.401 TD -0.0035 Tc -0.0466 Tw (An emergency responder reported, I think all the others had)Tj 0 -1.398 TD 0.0045 Tc 0.1253 Tw [(the same idea. )19.8(W)93.3(e)-0.3( done everything we could do. )13.8(Three)]TJ 0 -1.401 TD -0.0038 Tc -0.0293 Tw (different mental health providers reported The support sev-)Tj T* -0.003 Tc -0.0363 Tw (eral people received that they did a good job and that the fire)Tj 0 -1.398 TD -0.0039 Tc 0.0119 Tw (service was proud of their performance; The most impor-)Tj 0 -1.401 TD -0.0035 Tc -0.0322 Tw (tant component was dealing with the sensory stimulus as the)Tj T* -0.0104 Tw (response went well and there was not a great deal that could)Tj 25.5 64.2 TD -0.0038 Tc 0.0194 Tw (have been done; and After struggling to second guess the)Tj 0 -1.398 TD -0.0007 Tc 0.1249 Tw [(tactical decisions, most came to the conclusion that there)]TJ 0 -1.401 TD -0.0034 Tc 0.0637 Tw (had been nothing individually that could have changed the)Tj T* -0.004 Tc 0.0067 Tw (outcome. One of the CISM Peers noted, The most impor-)Tj 0 -1.398 TD 0.0026 Tc 0.125 Tw (tant discussions during this debriefing is that it appeared)Tj 0 -1.401 TD -0.0031 Tc -0.0155 Tw (that everyone performed their part in the incident to the best)Tj T* 0 Tc 0.125 Tw [(that could be expected. It was important for each of the)]TJ 0 -1.398 TD -0.0033 Tc 0.005 Tw (participants to hear this from their peers.)Tj 1.8 -2.001 TD -0.0051 Tc -0.0625 Tw (Catharsis and expression emerged through narrative that)Tj -1.8 -1.401 TD -0.0036 Tc 0.1008 Tw (included an emergency responder who identified the most)Tj 0 -1.398 TD -0.0037 Tc 0.0256 Tw (distressful aspect in his CISD experience as hearing a col-)Tj 0 -1.401 TD -0.0038 Tc 0.0322 Tw (league describe his nightmares about the mother screaming)Tj T* -0.0035 Tc -0.0365 Tw (and seeing his distress and yet his most important was that)Tj 0 -1.398 TD 0.1067 Tw [(I was not alone. )50.5(Another shared, There were tears... it)50.5(s)]TJ 0 -1.401 TD -0.0033 Tc -0.0146 Tw (hard to see a coworker who is always so strong break down.)Tj T* -0.008 Tc -0.0624 Tw (But it also made me respect that coworker and the team all the)Tj 0 -1.398 TD -0.0034 Tc 0.0174 Tw [(more. )32.7(Y)103.8(et another stated, I felt blessed to be able to share)]TJ 0 -1.401 TD -0.0035 Tc 0.0275 Tw (enough that I could feel cleansed. Mental health providers)Tj T* -0.0069 Tc -0.0621 Tw (also voiced the importance of the catharsis/expression theme.)Tj 0 -1.398 TD -0.0035 Tc -0.0292 Tw [(Anger was a strong factor)50.5(. )17.5(T)73.3(o)-0.2( be able to express it and have)]TJ 0 -1.401 TD -0.0014 Tc 0.1249 Tw [(others understand helped to dif)13.6(fuse it. )49.5(A)54.8( CISM Peer ex-)]TJ T* -0.004 Tc 0.0807 Tw (pressed Open honest communication was vital to this de-)Tj 0 -1.398 TD -0.0033 Tc 0.0755 Tw [(briefing. When the participants were finally able to admit)]TJ 0 -1.401 TD -0.0028 Tc 0.104 Tw (that they felt angry towards the parents in this situation it)Tj T* -0.0045 Tc -0.0625 Tw (made a difference.)Tj 1.8 -1.998 TD -0.0003 Tc 0.125 Tw (In addition to responding to the CIQ questions, each)Tj -1.8 -1.401 TD -0.0037 Tc 0.1107 Tw (informant was asked to indicate what statements reflected)Tj T* -0.0038 Tc 0.0773 Tw [(one)53.2(s experience of the CISD process. Pick the five most)]TJ 0 -1.398 TD -0.0033 Tc 0.1188 Tw (important items for participants in the debriefing you just)Tj 0 -1.401 TD -0.0035 Tc 0.0105 Tw [(described with 5 being the most important, 4 being the next)]TJ T* -0.0013 Tc 0.125 Tw (most important, and so on. These results were generally)Tj 0 -1.398 TD -0.0035 Tc 0.0862 Tw (consistent with the written descriptions of the process ele-)Tj 0 -1.401 TD -0.004 Tc -0.0622 Tw (ments. The team found rare instances where the written word)Tj T* -0.0034 Tc 0.0483 Tw (indicated a different factor than those chosen.)Tj 1.8 -1.998 TD -0.014 Tc -0.0625 Tw (Each informant group selected a different cluster of thera-)Tj -1.8 -1.401 TD -0.003 Tc 0.0335 Tw (peutic factors. Results are displayed in Figure 2. It is noted)Tj T* -0.0071 Tc -0.0625 Tw (that none of the informants were reporting on the same CISD,)Tj 0 -1.398 TD -0.0038 Tc 0.11 Tw (so comparison across the groups is not meaningful. How-)Tj 0 -1.401 TD 0.0017 Tc 0.1252 Tw [(ever)34.7(, additional analysis of the therapeutic factors by the)]TJ T* -0.0033 Tc -0.0462 Tw (type of incident resulted in different clusters emerging based)Tj 0 -1.398 TD 0.0269 Tw [(upon the event itself. )17.7(T)70.5(able 1 illustrates the clusters.)]TJ 1.8 -2.001 TD -0.0125 Tw [(In summary)62.7(, both the narrative responses and the thera-)]TJ -1.8 -1.401 TD 0.0005 Tc 0.125 Tw (peutic factor rating scale identified themes of therapeutic)Tj 0 -1.398 TD -0.0037 Tc 0.1 Tw (factors that emerged during the 38 CISD interventions in-)Tj 0 -1.401 TD -0.0031 Tc 0.0577 Tw [(cluded in this study)62.9(. )17.8(The findings were derived by consen-)]TJ T* -0.0034 Tc 0.0287 Tw [(sual analysis that included an auditor who is a Group )17.8(W)94.5(ork)]TJ ET endstream endobj 207 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 209 0 obj << /Length 6711 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (45)Tj /TT2 1 Tf 10 0 0 10 66 282.66 Tm -0.0037 Tc -0.0094 Tw [(Fellow in the )53.3(Association of Specialists in Group )17.3(W)94.1(ork, and)]TJ 0 -1.401 TD -0.0035 Tc -0.0183 Tw (were further supported in the selection and ranking of thera-)Tj T* 0.055 Tw (peutic factors statements used in other group work studies.)Tj /F1 1 Tf 11 0 0 11 83.25 225.99 Tm 0.1387 Tw [(LESSONS LEARNED FR)10(OM )91.9(THE CISD)]TJ 4.6364 -1.0909 TD 0.0134 Tc 0.1409 Tw (GROUP PROCESS)Tj /TT2 1 Tf 10 0 0 10 84 190.65 Tm -0.0101 Tc -0.0621 Tw (The emergence of the therapeutic factors, or mechanisms)Tj -1.8 -1.401 TD -0.0033 Tc -0.0111 Tw (of change, in group work have been previously identified as)Tj 0 -1.398 TD 0.0283 Tc 0.125 Tw (empirical support for the effectiveness of group work)Tj 0 -1.401 TD -0.0174 Tc -0.0624 Tw [(\(Burligame et al., 2004; Delucia-W)75.6(aack, 1997; Delucia-W)78.6(aack)]TJ T* -0.004 Tc -0.0625 Tw (& Bridford, 2004\). The therapeutic factors that emerged here)Tj 0 -1.398 TD -0.0036 Tc 0.0175 Tw (further support the conclusion that the CISD intervention is)Tj 0 -1.401 TD 0.0007 Tc 0.125 Tw (indeed a support group with both affective and cognitive)Tj T* -0.004 Tc -0.0625 Tw (elements. The Kivlighan and Holmes \(2004\) expression/pur-)Tj 0 -1.398 TD -0.0029 Tc -0.0156 Tw (pose typology of therapeutic factors serves as a useful inter-)Tj 25.5 20.4 TD -0.0032 Tc 0.0118 Tw (pretive tool for the current findings \(see Figure 1\). It is also)Tj 0 -1.401 TD -0.0034 Tc 0.1137 Tw (important to note that the selected therapeutic factors that)Tj T* -0.0048 Tc -0.0625 Tw (would typically occur in affective or cognitive insight groups)Tj 0 -1.398 TD 0.0099 Tc 0.125 Tw (\(psychotherapy groups\) were not endorsed by the infor-)Tj 0 -1.401 TD -0.0112 Tc -0.0621 Tw [(mants. Informants did endorse Catharsis and )18.8(V)66(i)0.1(carious Learn-)]TJ T* -0.0192 Tc [(ing which Kivlighan and Holmes \(2004\) identified as elements)]TJ 0 -1.398 TD -0.004 Tc -0.0625 Tw (for insight \(growth\) groups. It is important to recall that these)Tj 0 -1.401 TD -0.0036 Tc 0.0381 Tw (factors are consistent with mechanisms of change for crisis)Tj T* -0.0132 Tc -0.0624 Tw [(resolution \(Everly & Mitchell, 1999; Mitchell & Everly)61.8(, 1997;)]TJ 0 -1.398 TD -0.0214 Tc -0.06 Tw (Raphael, 1986\).)Tj 1.8 -2.001 TD -0.0032 Tc -0.0305 Tw [( Our findings reported that each type of informant indi-)]TJ -1.8 -1.401 TD -0.0036 Tc 0.1021 Tw [(cated a dif)17.4(ferent ranking of the therapeutic factors. )29.6(Y)103.6(alom)]TJ 0 -1.398 TD 0.0489 Tw (and Lesick noted that group leaders often view the process)Tj 0 -1.401 TD -0.0193 Tc -0.0625 Tw [(dif)16.7(ferently than group members \(Y)100.7(alom & Lesick, 2005\). None)]TJ T* -0.0037 Tc -0.0335 Tw (of the informants were reporting on the same CISD, so com-)Tj /F19 1 Tf 10 0 2.1256 10 110.4 724.59 Tm -0.0048 Tc -0.0167 Tw (Figure 2. )Tj /TT3 1 Tf 10 0 0 10 154.44 724.59 Tm -0.0047 Tc -0.0182 Tw (Ranking of therapeutic factor rankings by informant type and by composite findings.)Tj ET 0 0 0 0.1 k /GS1 gs 80.495 707.505 104.51 -31.01 re f 0 0 0 0.1 K 0.99 w 1000 M /GS2 gs 80.495 707.505 104.51 -31.01 re S BT 12 0 0 12 103.14 695.34 Tm 0 0 0 1 k 0.0006 Tc 0 Tw (Emergency)Tj -0.1875 -1.0825 TD 0.005 Tc (Responders)Tj ET 0 0 0 0.1 k /GS1 gs 197.495 707.505 103.51 -31.01 re B* BT 12 0 0 12 218.25 690.36 Tm 0 0 0 1 k /GS2 gs -0.0072 Tc 0.05 Tw (CISM Peers)Tj ET 0 0 0 0.1 k /GS1 gs 321.495 707.505 104.01 -31.01 re B* BT 12 0 0 12 339.99 695.34 Tm 0 0 0 1 k /GS2 gs 0.0417 Tw (CISM Mental)Tj 1.41 -1.0825 TD 0.0094 Tc 0 Tw (Health)Tj ET 0 0 0 0.1 k /GS1 gs 442.995 707.505 104.01 -31.01 re B* BT 12 0 0 12 466.14 689.85 Tm 0 0 0 1 k /GS2 gs 0.0041 Tc (Composite)Tj ET 0 0 0 1 K /GS1 gs 80.695 708.005 104.31 -168.51 re S 10 M 197.19 675.495 m 301.29 675.495 l S 1000 M 197.495 708.005 104.31 -168.51 re S 10 M 81 676.005 m 185.1 676.005 l 320.49 676.005 m 425.49 676.005 l S 1000 M 320.995 707.505 105.31 -168.51 re S 10 M 442.71 675.495 m 546.81 675.495 l S 1000 M 442.995 708.005 104.31 -168.51 re S BT 11 0 0 11 85.5 662.34 Tm /GS2 gs -0.005 Tc 0.0818 Tw ( Vicarious)Tj 0.8182 -1.0445 TD -0.0106 Tc 0 Tw (Learning)Tj -0.8182 -2.0918 TD -0.0047 Tc 0.1045 Tw ( Catharsis)Tj 0 -2.0891 TD -0.0053 Tc 0.0341 Tw ( Guidance &)Tj 0.8182 -1.0473 TD 0.0032 Tc 0 Tw (Universality\(tied\))Tj -0.8182 -2.0891 TD -0.0042 Tc -0.05 Tw ( Imparting)Tj 0.8182 -1.0473 TD -0.0093 Tc 0 Tw (Information)Tj 9.7718 9.4091 TD -0.0038 Tc 0.1409 Tw ( Self-Disclosure)Tj 0 -2.0891 TD 0.0003 Tc 0 Tw [()-467.8(Altruism)]TJ 0 -2.0918 TD -0.0035 Tc 0.1409 Tw [()-471.6(Acceptance &)]TJ 0.8182 -1.0445 TD 0.0032 Tc 0 Tw (Universality\(tied\))Tj -0.8182 -2.3182 TD -0.005 Tc 0.0818 Tw ( Vicarious)Tj 0.8182 -1.0773 TD -0.0106 Tc 0 Tw (Learning)Tj 10.4727 8.5936 TD -0.0037 Tc -0.0295 Tw ( Instillation of)Tj 0.8182 -1.0445 TD -0.0014 Tc 0 Tw (Hope)Tj -0.8182 -2.0918 TD 0.0067 Tc [()-461.4(Self-Disclosure)]TJ 0 -2.0891 TD 0.0103 Tc [()-457.8(Acceptance)]TJ 0 -2.3509 TD -0.0046 Tc 0.1273 Tw ( Universality)Tj 11.0291 7.6227 TD -0.0038 Tc 0.1409 Tw ( Self-Disclosure)Tj 0 -2.0918 TD 0.0103 Tc 0 Tw [()-457.8(Acceptance)]TJ 0 -2.0891 TD -0.0014 Tc [()-469.5(Hope)]TJ 0 -2.3509 TD -0.0046 Tc 0.1273 Tw ( Universality)Tj 10 0 0 10 292.89 480.99 Tm -0.0067 Tc -0.07 Tw (Table 1)Tj -6.639 -1.2 TD -0.005 Tc 0 Tw (Therapeutic Factors by Type of Event)Tj /F1 1 Tf -9.75 -2.598 TD -0.0084 Tc -0.0676 Tw [(Event )99(T)62.6(ype)-9233.4(T)77.6(op Ranked )97.3(Therapeutic F)12.6(actors)]TJ /TT3 1 Tf 0 -1.665 TD -0.0127 Tc -0.07 Tw (Graphic Death)Tj 14.25 0 TD -0.0052 Tc -0.0116 Tw (Hope, Altruism, and Acceptance)Tj -14.25 -1.752 TD -0.0632 Tw [(Malicious )7(Harm)-7505.2(Universality, Guidance, and Hope)]TJ 0 -1.749 TD -0.0104 Tc -0.07 Tw (LOD Death/Injury)Tj 14.25 0 TD -0.005 Tc 0.005 Tw (Acceptance, Self to Disclosure, Guidance)Tj -14.25 -1.749 TD -0.0048 Tc 0.0103 Tw [(Known )6.2(Victim)-8254.8(Universality, Catharsis, Self Disclosure)]TJ 0 -1.752 TD -0.005 Tc 0.0435 Tw [(Mass )9.1(Casualty)-7730(Self Disclosure, Acceptance, Altruism)]TJ 0 -1.749 TD -0.0048 Tc -0.023 Tw [(Officer )-38(Suicide)-7804.8(Impart Information, Family Norms, and Catharsis)]TJ ET /GS1 gs 65.495 496.005 493.51 -164.51 re S 10 M 65.01 454.995 m 558.6 454.995 l 65.01 438.495 m 558.3 438.495 l 66 421.005 m 558.81 421.005 l 65.19 403.485 m 558.99 403.485 l 65.19 385.995 m 558.99 385.995 l 65.19 367.695 m 558.81 367.695 l 65.49 351.015 m 558.51 351.015 l S endstream endobj 210 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F19 67 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 212 0 obj << /Length 8543 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.1375 Tw [(46 )]TJ /TT3 1 Tf 2.34 0 TD -0.0049 Tc (Pender and Prichard CISD Process Research Therapeutic Factors)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0033 Tc -0.0155 Tw (parison across the groups may also be due to the differences)Tj 0 -1.398 TD -0.0095 Tc -0.0625 Tw (in the event dynamics. In fact, additional analysis of the thera-)Tj 0 -1.401 TD -0.0028 Tc 0.1188 Tw (peutic factors by the type of incident resulted in different)Tj T* -0.0035 Tc 0.11 Tw (clusters emerging based upon the event itself. This event-)Tj 0 -1.398 TD -0.0169 Tw (based emergence of therapeutic themes tends to further sup-)Tj 0 -1.401 TD 0.0756 Tw (port the CISD protocols of event-driven processing, or the)Tj T* 0.0993 Tw [(normal reaction by normal people to an abnormal event)]TJ 0 -1.398 TD -0.0038 Tc -0.048 Tw (premise, that drives CISD group work.)Tj 1.8 -2.001 TD -0.0035 Tc 0.1041 Tw (Therefore, evidence of therapeutic factors support the)Tj -1.8 -1.401 TD -0.0037 Tc -0.0072 Tw (conclusion that the CISD interventions reported here shared)Tj 0 -1.398 TD 0.0588 Tw (common ground with the literature on affective and cogni-)Tj 0 -1.401 TD -0.0035 Tc -0.0366 Tw (tive support groups and with the literature on crisis interven-)Tj T* 0.0237 Tc 0.125 Tw (tion. Effectiveness of the CISD process may be better)Tj 0 -1.398 TD -0.0037 Tc -0.0417 Tw [(understood in terms of the mechanisms of change that occur)35.3(,)]TJ 0 -1.401 TD -0.0036 Tc -0.0514 Tw [(or do not occur)35.4(, as mediated through the perceptions of those)]TJ T* -0.0034 Tc 0.0672 Tw (that provide and those that receive the intervention than in)Tj 0 -1.398 TD -0.0032 Tc -0.0624 Tw [(trying to prove or disprove overall ef)17.8(ficacy)62.8(.)-6.4( )17.6(Themes from the)]TJ 0 -1.401 TD -0.0036 Tc 0.1069 Tw (narratives reported here confirmed that the CISD does re-)Tj T* -0.0037 Tc -0.0306 Tw (duce social isolation and promote adaptation to the demands)Tj 0 -1.398 TD -0.0225 Tc -0.0625 Tw (of ESR work.)Tj /F1 1 Tf 11 0 0 11 130.5 417.99 Tm 0.0247 Tc 0 Tw (CONCLUSIONS)Tj /TT2 1 Tf 10 0 0 10 72 394.65 Tm -0.0086 Tc -0.0625 Tw (Effective and ethical group work is rooted within empiri-)Tj -1.8 -1.401 TD -0.0007 Tc 0.125 Tw (cal evidence. The emergence of the therapeutic factors is)Tj 0 -1.398 TD -0.0034 Tc 0.0472 Tw (very important support for the usefulness of the CISD pro-)Tj 0 -1.401 TD 0 Tc 0.125 Tw (cess. The endorsement of factors supports the conclusion)Tj T* -0.0033 Tc 0.101 Tw (that the process, as reported here, is being conducted as a)Tj 0 -1.398 TD -0.0036 Tc 0.0069 Tw (support group with a specific crisis intervention theme. The)Tj 0 -1.401 TD -0.0034 Tc 0.1107 Tw (evidence that different events lead to different therapeutic)Tj T* 0.0883 Tw (factors is intriguing. Further research on the kind of event)Tj 0 -1.398 TD -0.003 Tc -0.0522 Tw [(and therapeutic factors may improve the field)51(s ability to im-)]TJ 0 -1.401 TD -0.0037 Tc 0.12 Tw (prove the process.)Tj 1.8 -2.001 TD -0.0045 Tc -0.0622 Tw (The decision to explore the CISD using well-established)Tj -1.8 -1.398 TD -0.0035 Tc 0.0491 Tw (group research methodology and consensual qualitative re-)Tj 0 -1.401 TD -0.0026 Tc 0.125 Tw (search has yielded important information about the group)Tj T* -0.0037 Tc 0.0377 Tw [(process aspects. )50.3(An adage in group work is the proof is in)]TJ 0 -1.398 TD -0.0034 Tc -0.0271 Tw (the process. The limitations of qualitative research )Tj /TT7 1 Tf 20.511 0 TD -0.0048 Tc 0 Tw (prohibit)Tj /TT2 1 Tf -20.511 -1.401 TD -0.0033 Tc -0.0486 Tw (the claim that the study has proven CISD to be effective. It)Tj T* 0.0775 Tw (has simply confirmed that effective and ethical group pro-)Tj 0 -1.398 TD -0.0035 Tc 0.01 Tw (cess did occur in the 38 CISD reports so considered.)Tj 1.8 -2.001 TD -0.0033 Tc -0.01 Tw [(W)94.5(ell-established pathways of lines of research in group)]TJ -1.8 -1.401 TD -0.0034 Tc 0.1032 Tw (work also offer the direction for future research. Inquiries)Tj 0 -1.398 TD -0.0026 Tc 0.125 Tw (often begin by gathering comprehensive process data and)Tj 0 -1.401 TD -0.0037 Tc 0.0068 Tw [(then evolve into quantitative methods. )50.2(As the research team)]TJ 25.5 63.399 TD -0.0033 Tc 0.0805 Tw (met and discussed the analysis of the CISD narratives, we)Tj 0 -1.398 TD -0.0567 Tw [(began the framework for a systematic rating scale that would)]TJ 0 -1.401 TD -0.0036 Tc 0.0456 Tw (allow future CISD reports to be coded into numerical data.)Tj T* 0.0738 Tw (Such a system would allow multiple reviewers, both those)Tj 0 -1.398 TD -0.0037 Tc 0.052 Tw (who are familiar with the CISD process and those who are)Tj 0 -1.401 TD -0.0035 Tc 0.0581 Tw (not, to code the narrative responses from remote locations.)Tj T* -0.0032 Tc 0.0806 Tw (After completing the analysis structure, we will be able to)Tj 0 -1.398 TD -0.0033 Tc 0.03 Tw (recruit additional coders and use the existing data set to es-)Tj 0 -1.401 TD -0.0029 Tc 0.0375 Tw (tablish the reliability and validity of the coding instrument.)Tj T* -0.0037 Tc 0.0519 Tw (Then the research efforts would seek to gain endorsements)Tj 0 -1.398 TD 0.0211 Tc 0.125 Tw (from emergency service trade unions and associations,)Tj 0 -1.401 TD -0.0036 Tc -0.0625 Tw (thereby increasing the number of ESR personnel reports, and)Tj T* -0.0038 Tc 0.0123 Tw (allowing for the collection of comparison data on ESR who)Tj 0 -1.398 TD -0.0035 Tc 0.093 Tw (do not attend or who are not offered a CISD intervention.)Tj 0 -1.401 TD -0.0031 Tc 0.0028 Tw (This is an exploratory work intended to yield group process)Tj T* -0.0035 Tc -0.0371 Tw (findings. Process commentary is meant to provoke practitio-)Tj 0 -1.398 TD -0.003 Tc 0.049 Tw (ners to deeply engage in reflection about what they do and)Tj 0 -1.401 TD -0.0014 Tc 0.0067 Tw (why they do it.)Tj /F1 1 Tf 11 0 0 11 388.89 432 Tm 0.021 Tc 0 Tw (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 309 398.64 Tm -0.0038 Tc 0.0369 Tw [(Ahn, H. & )17.1(W)94(ampold, B.E. \(2001\). )17.1(Where oh where are the)]TJ 1.2 -1.398 TD -0.0033 Tc -0.0334 Tw [(specific ingredients? )50.6(A)58.9( meta-analysis of component stud-)]TJ 0 -1.401 TD -0.0028 Tc 0.0326 Tw [(ies of counseling and psychotherapy)60.2(. )]TJ /TT7 1 Tf 15.609 0 TD -0.0042 Tc 0.0325 Tw (Journal of Coun-)Tj -15.609 -1.401 TD -0.0038 Tc -0.0113 Tw [(seling and Psychology)50.2(, 48,)]TJ /TT2 1 Tf 10.566 0 TD -0.0049 Tc -0.015 Tw [( 251-271)]TJ -11.766 -1.8 TD -0.0075 Tc -0.0624 Tw [(Bisson, J.I., McFarlane, )46.6(A.C., & Rose, S. \(2000\). Psychologi-)]TJ 1.2 -1.398 TD -0.0034 Tc -0.0272 Tw [(cal debriefing. In E.B.F)74.6(. Foa, J. 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Psychological debriefing: Controversy)]TJ 1.2 -1.401 TD -0.0036 Tc 0.1075 Tw (and challenge. )Tj /TT7 1 Tf 6.189 0 TD -0.0041 Tc 0.108 Tw (Australian and New Zealand Journal of)Tj -6.189 -1.401 TD -0.0107 Tc -0.0593 Tw [(Psychiatry)52.1(,)-0.7( 34)]TJ /TT2 1 Tf 5.52 0 TD -0.0103 Tc -0.06 Tw (, 929-939.)Tj -6.72 -1.8 TD -0.0623 Tw [(Deahl, M.P)109.7(., Srinivasan, M., Jones, N., Neblett, C., & Jolly)64.7(, )49.9(A.)]TJ 1.2 -1.398 TD -0.0077 Tc -0.0626 Tw [(\(2001\). Evaluating psychological debriefing: )52.2(Are we mea-)]TJ 0 -1.401 TD -0.0033 Tc 0.0688 Tw (suring the right outcomes? )Tj /TT7 1 Tf 11.076 0 TD -0.0042 Tc 0.0699 Tw [(Journal of T)52.8(raumatic S)28.8(t)2.8(r)31.8(ess,)]TJ -11.076 -1.401 TD -0.034 Tc 0 Tw (14)Tj /TT2 1 Tf 0.945 0 TD -0.027 Tc -0.06 Tw (, 527-529.)Tj -2.145 -1.8 TD -0.0049 Tc -0.0401 Tw [(DeLucia-W)76.1(aack, J.L. )]TJ 8.5455 0 TD -0.0034 Tc -0.0416 Tw [(\(1997\). Measuring the ef)17.6(fectiveness of)]TJ -7.3455 -1.398 TD -0.0033 Tc 0.0972 Tw [(group work: )53.7(A)58.9( review and analysis of process and out-)]TJ 0 -1.401 TD -0.0039 Tc 0.08 Tw (come measures. )Tj /TT7 1 Tf 6.741 0 TD -0.004 Tc 0.0829 Tw [(Journal for Specialists in Gr)32(oup W)86(ork,)]TJ -6.741 -1.401 TD -0.034 Tc 0 Tw (22)Tj /TT2 1 Tf 0.945 0 TD -0.027 Tc -0.06 Tw (, 277-293.)Tj -2.145 -1.8 TD -0.0274 Tc -0.0607 Tw [(DeLucia-W)77.6(aack, J.L. )]TJ 8.0522 0 TD -0.0259 Tc -0.0622 Tw (Bridbord, K.H. \(2004\). Measures of group)Tj -6.8522 -1.398 TD 0.0079 Tc 0.125 Tw (process, dynamics, climate, leadership behaviors, and)Tj 0 -1.401 TD -0.0138 Tc -0.0621 Tw [(therapeutic factors: )52.2(A)57.4( review)58.2(. In J.L. DeLucia-W)76.2(aack, D.A.)]TJ T* -0.0032 Tc -0.0452 Tw [(Gerrity)59.8(, C.R. Kalodner)38.8(, & M.T)71.8(. Riva \(Eds.\), )]TJ /TT7 1 Tf 17.406 0 TD -0.005 Tc -0.05 Tw (Handbook of)Tj -17.406 -1.398 TD 0.0164 Tc 0.125 Tw (group counseling and psychotherapy)Tj /TT2 1 Tf 15.741 0 TD 0.0173 Tc [( \(pp. 120-135.\).)]TJ -15.741 -1.401 TD -0.0041 Tc 0.0116 Tw (Thousand Oaks, CA: Sage.)Tj -1.2 -1.8 TD -0.0036 Tc -0.0621 Tw [(Everly)59.4(, G)116.4(.S., Jr)59.4(. & Boyle, S.H. \(1999\). Critical incident stress)]TJ 1.2 -1.401 TD -0.0034 Tc 0.0651 Tw [(debriefing \(CISD\): )50.7(A)58.8( meta-analysis. )]TJ /TT7 1 Tf 14.835 0 TD -0.0041 Tc 0.065 Tw [(International Jour)16.9(-)]TJ -14.835 -1.398 TD -0.0038 Tc -0.03 Tw (nal of Emergency Mental Health, 1)Tj /TT2 1 Tf 13.836 0 TD -0.035 Tw (, 165-168.)Tj -15.036 -1.8 TD -0.0308 Tc -0.062 Tw [(Everly)62.2(, G)122.2(.S., Jr)53.2(., Flannery)59.2(, R.B., Jr)56.2(., & Eyler)38.2(,)-7.1( )17.5(V)136.4(.A. \(2002\). Critical)]TJ 1.2 -1.401 TD -0.0039 Tc 0.0259 Tw [(incident stress management \(CISM\): )50.2(A)58.3( statistical review)]TJ T* -0.0033 Tc -0.0616 Tw (of the literature. )Tj /TT7 1 Tf 6.42 0 TD -0.0046 Tc -0.0592 Tw [(Psychiatric Quar)-4.6(terly)49.4(, 73)]TJ /TT2 1 Tf 9.969 0 TD -0.004 Tc -0.065 Tw (\(3\), 171-182.)Tj -17.589 -1.8 TD -0.0266 Tc -0.0622 Tw [(Everly)63.4(, G)117.4(.)0.2(S., Jr)54.4(., Flannery)63.4(, R.B.,Jr)51.4(., & Mitchell, J.T)75.4(. \(2000\). 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Post-trauma debriefing: )18.1(The)]TJ 1.2 -1.401 TD -0.0032 Tc 0.025 Tw (road too frequently traveled [commentary]. )Tj /TT7 1 Tf 17.541 0 TD -0.0042 Tc 0.03 Tw (Lancet, 360)Tj /TT2 1 Tf 4.71 0 TD 0 Tc 0 Tw (,)Tj -22.251 -1.398 TD -0.0511 Tc (741-742.)Tj 24.3 63.198 TD -0.0199 Tc -0.0622 Tw [(Gist, R., Lubin, B., & Redburn, B.G)115.1(. \(1998\). Psychosocial, eco-)]TJ 1.2 -1.398 TD -0.0061 Tc -0.0625 Tw (logical, and community perspectives on disaster response.)Tj /TT7 1 Tf 0 -1.401 TD -0.0038 Tc 0.0041 Tw (Journal of Personal and Interpersonal Loss, 3)Tj /TT2 1 Tf 18.384 0 TD -0.0031 Tc 0.005 Tw (, 25-51.)Tj -19.584 -1.8 TD 0.0216 Tw [(Hill, C., Knox, S., )18(Thompson, B., )15(W)55.7(illiams, E., Hess, S., &)]TJ 1.2 -1.401 TD -0.0033 Tc 0.0832 Tw [(Ladany)62.7(, N. \(2005\). Consensual qualitative research: )50.6(A)9.9(n)]TJ 0 -1.398 TD -0.0038 Tc 0 Tw (update. )Tj /TT7 1 Tf 3.159 0 TD -0.0041 Tc 0.02 Tw [(Journal of Counseling Psychology)49.9(, 52)]TJ /TT2 1 Tf 15.192 0 TD -0.0038 Tc 0.025 Tw (, 196-205.)Tj -19.551 -1.8 TD -0.0133 Tc -0.0622 Tw [(Hill, C., )16.8(Thompson, B., & )13.8(W)57.6(illiams, E. \(1997\). )43.8(A)60.9( guide to con-)]TJ 1.2 -1.401 TD -0.0036 Tc 0.0412 Tw (ducting consensual qualitative research. )Tj /TT7 1 Tf 16.209 0 TD -0.0046 Tc 0.045 Tw (The Counseling)Tj -16.209 -1.401 TD -0.0054 Tc -0.0625 Tw (Psychologist, 25, )Tj /TT2 1 Tf 6.891 0 TD -0.007 Tc 0 Tw (517-572.)Tj -8.091 -1.8 TD -0.0243 Tc -0.062 Tw [(Hobfoll, S.E, )17.9(W)97.5(atson, P)113.7(., Bell. C.C., Bryant, R.A., Brymer)38.7(, M.J.,)]TJ 1.2 -1.398 TD -0.0033 Tc 0.0756 Tw (Friedman, M.J., et al \(2007\). Five essential elements of)Tj 0 -1.401 TD -0.0056 Tc -0.0625 Tw (immediate and midterm mass trauma intervention: Em-)Tj T* -0.0036 Tc 0.02 Tw (pirical evidence.)Tj /TT7 1 Tf 6.57 0 TD -0.0039 Tc [( Psychiatry: Interpersonal & Biological)]TJ -6.57 -1.398 TD -0.0143 Tc 0 Tw (Processes)Tj /TT2 1 Tf 3.876 0 TD 0 Tc ( )Tj /TT7 1 Tf 0.18 0 TD -0.0145 Tc (70,)Tj /TT2 1 Tf 1.209 0 TD -0.0141 Tc -0.06 Tw [( 283-315.)]TJ -6.465 -1.8 TD -0.0093 Tc -0.0622 Tw [(Hokanson, M., & )17.7(W)52.5(irth, B. \(2000\). )14.7(The critical incident stress)]TJ 1.2 -1.401 TD -0.002 Tc 0.125 Tw [(debriefing process for the Los )52(Angeles county fire de-)]TJ T* -0.0039 Tc -0.0202 Tw [(partment: )52.9(Automatic and ef)14.1(fective. )]TJ /TT7 1 Tf 13.965 0 TD -0.0042 Tc -0.02 Tw (International Journal)Tj -13.965 -1.398 TD -0.0039 Tc -0.0487 Tw (of Emergency Mental Health, 2)Tj /TT2 1 Tf 12.276 0 TD -0.05 Tw (, 249-257.)Tj -13.476 -1.8 TD -0.0031 Tc 0.0833 Tw [(Kenardy)62.9(, J.A. \(1998\). 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Thousand Oaks, CA: Sage.)]TJ -6.975 -1.8 TD -0.0032 Tc 0.0269 Tw (Kivlighan, D.M., & Jauquet, C.A. \(1990\). Quality of group)Tj 1.2 -1.401 TD -0.0038 Tc -0.0409 Tw (member agendas and group session climate. )Tj /TT7 1 Tf 17.454 0 TD -0.0048 Tc -0.045 Tw (Small Group)Tj -17.454 -1.398 TD -0.005 Tc -0.06 Tw (Research, 21)Tj /TT2 1 Tf 5.106 0 TD -0.0042 Tc (, 205.)Tj -6.306 -1.8 TD -0.0235 Tc -0.0625 Tw (Kivlighan, D.M., Multon, K.D., & Brussant, D.C. \(1996\). 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In)]TJ 0 -1.401 TD -0.01 Tc -0.0621 Tw [(J.L. DeLucia-W)80(aack, D.A. Gerrity)59(, C.R. Kalodner)35(, & M.T)68(.)]TJ T* -0.0032 Tc 0.015 Tw (Riva \(Eds.\), )Tj /TT7 1 Tf 5.046 0 TD -0.0041 Tc 0.018 Tw (Handbook of group counseling and psycho-)Tj -5.046 -1.398 TD -0.0051 Tc 0 Tw (therapy)Tj /TT2 1 Tf 3.024 0 TD -0.0037 Tc -0.0333 Tw [( \(pp. 23-36\). Thousand Oaks: CA: Sage.)]TJ -4.224 -1.8 TD -0.0047 Tc -0.0617 Tw [(Mann, C., & S)13.3(tewart, F)76.3(.)-0.4( \(2000\). )]TJ /TT7 1 Tf 12.45 0 TD -0.0054 Tc -0.0634 Tw [( Internet communication and)]TJ -11.25 -1.401 TD -0.0038 Tc -0.025 Tw (qualitative research: A handbook for researching online.)Tj /TT2 1 Tf T* -0.0044 Tc -0.005 Tw (London: Sage.)Tj -1.2 -1.8 TD -0.0026 Tc -0.0587 Tw [(McNally)60.4(, R.J., Bryant, R.A., & Ehlers, )54.6(A. \(2003\). Does early)]TJ 1.2 -1.398 TD -0.0033 Tc 0.053 Tw (psychological intervention promote recovery from post-)Tj 0 -1.401 TD 0.0097 Tc 0.125 Tw (traumatic stress? )Tj /TT7 1 Tf 7.365 0 TD 0.009 Tc (Psychological Science in the Public)Tj -7.365 -1.401 TD -0.011 Tc -0.06 Tw (Interest, 4)Tj /TT2 1 Tf 3.879 0 TD (, 45-79.)Tj -5.079 -1.8 TD -0.0185 Tc -0.0623 Tw [(Mitchell, J.T)71.5(., & Everly)62.5(, G)116.5(.S., Jr)50.5(. \(1997\). )]TJ /TT7 1 Tf 15.201 0 TD -0.0198 Tc -0.0622 Tw [(Critical incident str)34.2(ess)]TJ -14.001 -1.398 TD -0.0038 Tc 0.0965 Tw (debriefing: An operations manual for the prevention of)Tj 0 -1.401 TD 0.0167 Tw (traumatic stress among emergency services and disaster)Tj T* -0.0046 Tc 0.0454 Tw [(workers \(r)31.4(ev)67.4(. 2nd ed.\))]TJ /TT2 1 Tf 8.799 0 TD -0.0034 Tc 0.0459 Tw [(. Ellicott City)59.6(, MD: Chevron Pub-)]TJ -8.799 -1.398 TD -0.004 Tc -0.03 Tw (lishing Corporation.)Tj -1.2 -1.8 TD -0.0169 Tc -0.0623 Tw [(Mitchell, J.T)73.1(., & Everly)58.1(, G)118.1(.)-1.6(S., Jr)52.1(. \(2000\). Critical incident stress)]TJ 1.2 -1.401 TD -0.0037 Tc -0.0475 Tw (management and critical incident stress debriefings: Evo-)Tj T* -0.0035 Tc 0.0039 Tw [(lutions, ef)14.5(fects and outcomes. In B. Raphael & J. )17.5(W)55.3(ilson)]TJ 0 -1.398 TD 0.0014 Tc 0 Tw (\(Eds.\), )Tj /TT7 1 Tf 3.054 0 TD 0.0006 Tc 0.1251 Tw [(Psychological debriefing: Theor)-5.4(y)54.4(,)-0.4( practice and)]TJ -3.054 -1.401 TD -0.0046 Tc 0 Tw (evidence)Tj /TT2 1 Tf 3.465 0 TD -0.0035 Tc 0.011 Tw [( \(pp. 71-90\). Cambridge: Cambridge University)]TJ -3.465 -1.401 TD 0.0077 Tc 0 Tw (Press.)Tj -1.2 -1.8 TD -0.0037 Tc -0.0315 Tw (National Institute of Mental Health \(NIMH\). \(2002\). Mental)Tj 1.2 -1.398 TD -0.0026 Tc 0.125 Tw (health & mass violence: Evidence-based early psycho-)Tj 0 -1.401 TD -0.0037 Tc 0.1175 Tw (logical interventions for victims/survivors of mass vio-)Tj T* 0.0394 Tw [(lence: )50.3(A)58.5( workshop to reach consensus on best practices:)]TJ 0 -1.398 TD -0.0046 Tc 0.0554 Tw [(W)93.2(ashington DC: )52.8(Author)49.4(.)]TJ -1.2 -1.8 TD -0.002 Tc 0.125 Tw [(Patton, M.Q. \(2002\). )]TJ /TT7 1 Tf 8.925 0 TD (Qualitative research and evaluation)Tj -7.725 -1.401 TD -0.0043 Tc 0.0275 Tw (methods \(3rd ed.\).)Tj /TT2 1 Tf 7.314 0 TD -0.0039 Tc 0.03 Tw [( Thousand Oaks, CA: Sage.)]TJ -8.514 -1.8 TD -0.0034 Tc -0.0067 Tw (Raphael, B. \(1986\). )Tj /TT7 1 Tf 8.025 0 TD -0.0037 Tc -0.01 Tw (When disaster strikes.)Tj /TT2 1 Tf 8.706 0 TD -0.0043 Tc -0.0083 Tw [( New )31.7(Y)102.9(ork: Basic)]TJ -15.531 -1.401 TD -0.0062 Tc 0 Tw (Books.)Tj -1.2 -1.8 TD -0.0032 Tc 0.0088 Tw [(Robinson, R.C., & Mitchell, J.T)71.8(. \(1993\). Evaluation of psy-)]TJ 1.2 -1.398 TD 0.0001 Tc 0.125 Tw (chological debriefings. )Tj /TT7 1 Tf 9.669 0 TD -0.0002 Tc 0.1251 Tw [(Journal of T)50.8(raumatic S)26.8(t)6.8(r)29.8(ess, 6)]TJ /TT2 1 Tf 12.582 0 TD 0 Tc 0 Tw (,)Tj -22.251 -1.401 TD -0.0511 Tc (367-382.)Tj -1.2 -1.8 TD -0.015 Tc -0.0622 Tw (Rose, S., & Bisson, J.I. \(1998\). Brief early psychological inter-)Tj 1.2 -1.401 TD -0.0034 Tc -0.0516 Tw [(ventions following trauma: )50.9(A)58.8( systematic review of the lit-)]TJ 0 -1.398 TD -0.0033 Tc 0 Tw (erature. )Tj /TT7 1 Tf 3.219 0 TD -0.0041 Tc -0.0299 Tw [(Journal of T)49.9(raumatic S)28.9(t)2.9(r)31.9(ess, 1)70.9(1)]TJ /TT2 1 Tf 12.261 0 TD -0.0037 Tc (, 697-710.)Tj -16.68 -1.8 TD -0.0027 Tc -0.047 Tw [(Rose, S., Bisson, J.I., & )15.2(W)98.1(essely)63.3(, S.C. \(2001\). Psychological)]TJ 1.2 -1.401 TD -0.0036 Tc 0.1175 Tw (debriefing for preventing post traumatic stress disorder)Tj T* 0.0242 Tc 0 Tw (\(PTSD\). )Tj /TT7 1 Tf 3.936 0 TD 0.0252 Tc 0.125 Tw (Cochrane Database of Systematic Reviews)Tj /TT2 1 Tf -3.936 -1.398 TD -0.0128 Tc -0.0625 Tw ([Online version], 2001.)Tj 24.3 61.398 TD -0.0042 Tc -0.0618 Tw [(Shalev)58.8(,)-7.3( )53.1(A)6(.)6(Y)124.8(. \(2000\). S)16.8(tress management and debriefing: His-)]TJ 1.2 -1.398 TD -0.0033 Tc -0.0061 Tw (torical concepts and present patterns. In B. Raphael, & J.)Tj 0 -1.401 TD -0.0032 Tc 0.125 Tw [(W)55.6(ilson \(Eds.\), )]TJ /TT7 1 Tf 6.204 0 TD -0.0038 Tc [(Psychological debriefing: Theor)-6.8(y)50.1(,)-0.1( prac-)]TJ -6.204 -1.401 TD -0.0134 Tc -0.06 Tw (tice and evidence)Tj /TT2 1 Tf 6.594 0 TD -0.0138 Tc -0.063 Tw [( \(pp. 17-31\). Cambridge: Cambridge Uni-)]TJ -6.594 -1.398 TD -0.0025 Tc 0.1 Tw (versity Press.)Tj -1.2 -1.8 TD -0.0197 Tc -0.0623 Tw [(Smokowski, P)103.3(.R., Rose, S.D., & Bacallo, M.L. \(2001\). Damag-)]TJ 1.2 -1.401 TD -0.0025 Tc 0.125 Tw (ing experiences in therapeutic groups: How vulnerable)Tj T* -0.0031 Tc (consumers become group causalities. )Tj /TT7 1 Tf 15.525 0 TD -0.0037 Tc (Small Group Re-)Tj -15.525 -1.398 TD -0.0136 Tc -0.06 Tw (search, 32)Tj /TT2 1 Tf 3.975 0 TD (, 223-251.)Tj -5.175 -1.8 TD -0.0037 Tc 0.0002 Tw [(V)112.5(an Emmerik, )53.5(A.A.P)107.3(., Kamphuis, J.H., Hulsbosch, )50.5(A.M., &)]TJ 1.2 -1.401 TD -0.0175 Tc -0.0623 Tw [(Emmelkamp, P)108.5(.M.G)117.5(. \(2002\). Single session debriefing after)]TJ T* -0.003 Tc -0.0574 Tw [(psychological trauma: )51.1(A)59.2( meta-analysis. )]TJ /TT7 1 Tf 15.624 0 TD -0.0042 Tc -0.06 Tw (Lancet, 360)Tj /TT2 1 Tf 4.62 0 TD -0.0034 Tc (, 766-)Tj -20.244 -1.398 TD -0.0583 Tc 0 Tw (771.)Tj -1.2 -1.8 TD 0.0051 Tc 0.125 Tw [(W)93.9(ampold, B.E. \(2001\). )]TJ /TT7 1 Tf 10.029 0 TD 0.0046 Tc 0.1248 Tw [(The gr)31.6(eat psychotherapy debate:)]TJ -8.829 -1.401 TD -0.0039 Tc 0.06 Tw (Models, methods, and findings)Tj /TT2 1 Tf 12.321 0 TD -0.0041 Tc 0.0617 Tw (. Mahwah, NJ: Lawrence)Tj -12.321 -1.401 TD -0.0045 Tc -0.0395 Tw (Erlbaum Associates.)Tj -1.2 -1.8 TD -0.0034 Tc -0.0264 Tw [(W)94.4(ee, D.F)77.6(., Mills, D.M., & Koelher)38.6(, G)116.6(.)-1( \(1999\). )17.7(The ef)14.6(fects of)]TJ 1.2 -1.398 TD 0.0509 Tw (critical incident stress debriefing on emergency medical)Tj 0 -1.401 TD -0.0038 Tc -0.0491 Tw [(services personnel following the Los )54.1(Angeles civil distur)17.2(-)]TJ T* 0.0322 Tc 0 Tw (bance. )Tj /TT7 1 Tf 3.189 0 TD 0.0329 Tc 0.125 Tw (International Journal of Emergency Mental)Tj -3.189 -1.398 TD -0.0103 Tc -0.06 Tw (Health, 1)Tj /TT2 1 Tf 3.576 0 TD -0.0106 Tc (, 33-38.)Tj -4.776 -1.8 TD -0.0041 Tc 0.0548 Tw [(Wheeler)34.9(, J.T)70.9(., & Kivlighan, )]TJ 11.4096 0 TD -0.0037 Tc 0.0536 Tw [(D.M. \(1995\). )14.2(Things unsaid in)]TJ -10.2096 -1.401 TD 0.0056 Tc 0.125 Tw [(group counseling: )50.6(An empirical taxonomy)62.6(.)-5.4( )]TJ /TT7 1 Tf 18.189 0 TD 0.0053 Tc (Journal of)Tj -18.189 -1.401 TD -0.0042 Tc -0.01 Tw (Counseling & Development, 73)Tj /TT2 1 Tf 12.465 0 TD -0.0037 Tc -0.015 Tw (, 586-591.)Tj -13.665 -1.8 TD 0.0003 Tc 0.125 Tw [(W)53.1(i)-0.3(lson, J.P)108.3(.)-0.6( \(1999\). )12.3(Theoretical perspectives of traumatic)]TJ 1.2 -1.398 TD 0.0033 Tc (stress and debriefings. )Tj /TT7 1 Tf 9.624 0 TD 0.003 Tc (International Journal of Emer-)Tj -9.624 -1.401 TD -0.0039 Tc -0.0383 Tw (gency Mental Health, 1)Tj /TT2 1 Tf 9.189 0 TD -0.0036 Tc -0.04 Tw (, 267-273.)Tj -10.389 -1.8 TD -0.0137 Tc -0.062 Tw [(W)54.1(ilson, J.P)106.3(., & Sigman, M.R. \(2000\). )16.4(Theoretical perspectives)]TJ 1.2 -1.401 TD -0.0036 Tc -0.0133 Tw [(of traumatic stress and debriefings. In B.W)86.4(. Raphael & J.)]TJ 0 -1.398 TD -0.0032 Tc 0.125 Tw [(W)55.6(ilson \(Eds.\), )]TJ /TT7 1 Tf 6.204 0 TD -0.0038 Tc [(Psychological debriefing: Theor)-6.8(y)50.1(,)-0.1( prac-)]TJ -6.204 -1.401 TD -0.0134 Tc -0.06 Tw (tice and evidence)Tj /TT2 1 Tf 6.594 0 TD -0.0138 Tc -0.063 Tw [( \(pp. 58-68\). Cambridge: Cambridge Uni-)]TJ -6.594 -1.401 TD -0.0025 Tc 0.1 Tw (versity Press.)Tj -1.2 -1.8 TD -0.0032 Tc 0.0867 Tw [(Y)104(a)-0.1(lom, I.D. \(1970\). )]TJ /TT7 1 Tf 8.289 0 TD -0.0042 Tc 0.0894 Tw [(Theor)-7.2(y and practice of gr)31.8(oup psycho-)]TJ -7.089 -1.398 TD -0.0076 Tc 0 Tw (therapy)Tj /TT2 1 Tf 3.006 0 TD -0.0078 Tc -0.0616 Tw [(. NY)88.2(: Basic Books.)]TJ -4.206 -1.8 TD -0.0032 Tc 0.0867 Tw [(Y)104(a)-0.1(lom, I.D. \(1995\). )]TJ /TT7 1 Tf 8.289 0 TD -0.0042 Tc 0.0894 Tw [(Theor)-7.2(y and practice of gr)31.8(oup psycho-)]TJ -7.089 -1.401 TD -0.0043 Tc -0.0075 Tw (therapy \(4th ed.\))Tj /TT2 1 Tf 6.609 0 TD -0.004 Tc -0.0101 Tw [(. NY)86(: Basic Books.)]TJ -7.809 -1.8 TD -0.0215 Tc -0.0625 Tw [(Y)106.7(alom, I.D., & Lesick, M. \(2005\). )]TJ /TT7 1 Tf 12.819 0 TD -0.0231 Tc -0.0616 Tw [(Theor)-5.1(y and practice of gr)30.9(oup)]TJ -11.619 -1.401 TD -0.0041 Tc 0.005 Tw (psychotherapy \(5th. ed.\))Tj /TT2 1 Tf 9.636 0 TD 0.0064 Tw [(. NY)85.9(: Basic Books.)]TJ /TT7 1 Tf 9 0 0 9 405.75 123 Tm -0.005 Tc 0.0078 Tw [(Manuscript Received: March 22, 2008)]TJ 6 -1.7767 TD -0.0045 Tc -0.0291 Tw [(Accepted: April 2, 2008)]TJ ET endstream endobj 220 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 222 0 obj << /Length 6038 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (49)Tj /TT3 1 Tf 7 0 0 7 125.49 726.66 Tm -0.0061 Tc 0.021 Tw [(International Journal of Emergency Mental Health, Vol. 10, No. 1, pp.49-60 2008 Chevron Publishing ISSN 1522-4821)]TJ /TT6 1 Tf 10 0 0 10 102.99 496.86 Tm -0.0041 Tc 0 Tw (Abstract: )Tj /TT7 1 Tf 4.086 0 TD -0.0035 Tc 0.0985 Tw (The purpose of the study was to investigate the impact of aerobic exercise on the severity of)Tj -4.086 -1.302 TD 0.0032 Tc 0.1251 Tw [(symptoms of Posttraumatic S)33.2(t)1.2(r)33.2(ess Disor)33.2(der \(PTSD\), depr)33.2(ession, and anxiety)48.2(. T)72.2(welve institutionalized)]TJ 0 -1.299 TD -0.0008 Tc 0.125 Tw (female adolescents completed a 15-session aerobic exercise program consisting of moderate-intensity)Tj T* -0.0041 Tc 0.0436 Tw [(walking. )16.8(All participants completed the Child PTSD Symptom Scale \(CPSS\), T)49.9(rauma Symptom Checklist)]TJ 0 -1.302 TD -0.0044 Tc 0.1009 Tw [(for Childr)28.6(en \(TSCC\), Multidimensional )16.6(Anxiety Scale for Childr)31.6(en \(MASC\), and Childr)31.6(en)124.6(s Depr)31.6(ession)]TJ 0 -1.299 TD -0.0036 Tc 0.046 Tw (Inventory \(CDI\) twice at pretest. Data were collected twice during an extended baseline period, at post-)Tj T* -0.0041 Tc 0.0268 Tw [(inter)-7.1(vention, and again at a 1-month follow-up assessment. 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[International)]TJ 0 -1.302 TD -0.0035 Tc 0.0688 Tw [(Journal of Emergency Mental Health, 2008, 10\(1\), pp. 49-60].)]TJ /TT1 1 Tf 9 0 0 9 207.75 288 Tm -0.0054 Tc 0.0056 Tw (Key words: )Tj /TT7 1 Tf 5.1233 0 TD -0.0049 Tc 0.0069 Tw [(PTSD, trauma, anxiety)51.8(, depr)35.1(ession, aer)35.1(obic exer)35.1(cise)]TJ ET /GS1 gs 66.99 166.245 m 302.01 166.245 l S BT 9 0 0 9 66.99 148.5 Tm /GS2 gs -0.0045 Tc -0.035 Tw (Ann B. Diaz, PsyD, is a school psychologist in Clarkstown Central)Tj 0 -1.2233 TD 0.0043 Tc 0.1254 Tw [(School District, New City)47.6(,)-5.2( )-4.8(N)-5.2(Y)84.3(. Rober)-5.7(t Motta, PhD, )14.7(ABPP)14.3( is a)]TJ 0 -1.22 TD -0.006 Tc -0.0621 Tw [(p)6.5(r)30.7(ofessor in the Dept of Psychology at Hofstra University)50.7(, wher)30.7(e he)]TJ 0 -1.2233 TD -0.0048 Tc 0.0944 Tw (is Director of the School-Community PsyD Program. This study)Tj T* -0.0116 Tw [(was conducted by the primar)-4.8(y author)108.5(, under the super)-4.8(vision of the)]TJ 0 -1.22 TD -0.0175 Tc -0.0619 Tw [(second author)102.5(, in partial fulfillment of the r)32.5(equir)32.5(ements for a doctoral)]TJ 0 -1.2233 TD -0.0013 Tc 0.1251 Tw [(degr)32(ee in School-Community Psychology at Hofstra University)48.7(.)]TJ T* -0.0051 Tc -0.0155 Tw (Correspondence should be directed to abdiaz@optonline.net)Tj /F1 1 Tf 14 0 0 14 150.75 629.34 Tm -0.0056 Tc 0.1347 Tw (The Effects of an Aerobic Exercise Program on)Tj -4.3114 -1.1421 TD 0.0019 Tc 0.1373 Tw [(P)38.9(osttraumatic Stress Disor)16.9(der Symptom Se)6.2(verity in Adolescents)]TJ /TT2 1 Tf 10 0 0 10 84.99 246.15 Tm -0.0033 Tc -0.0028 Tw (The purpose of the study was to investigate the impact)Tj -1.8 -1.401 TD -0.0034 Tc 0.0608 Tw (of moderate-intensity aerobic exercise on PTSD symptom)Tj 0 -1.398 TD -0.0031 Tc -0.0078 Tw (severity in children. Past findings with regard to the effects)Tj 0 -1.401 TD -0.0033 Tc -0.0287 Tw [(of aerobic exercise on various aspects of children)50.7(s psycho-)]TJ T* -0.0032 Tc 0.07 Tw (logical adjustment demonstrate that such physical activity)Tj 12 0 0 12 407.4 561.66 Tm -0.01 Tc -0.0625 Tw (Robert Motta)Tj 10 0 0 10 401.01 549 Tm 0.0017 Tc 0 Tw (Hofstra University)Tj 12 0 0 12 155.76 561.66 Tm -0.0281 Tc -0.0604 Tw (Ann B. Diaz)Tj 10 0 0 10 89.76 549 Tm -0.0045 Tc -0.0625 Tw [(Clarkson Central School District, New City)61.5(, NY)]TJ 23.124 -30.336 TD -0.0033 Tc -0.025 Tw (is related to significant benefits in social, emotional, and be-)Tj 0 -1.398 TD -0.0037 Tc -0.0478 Tw [(havioral functioning \(Basile, Motta, & )53.4(Alison, 1995; Brown,)]TJ 0 -1.401 TD -0.0109 Tc -0.0625 Tw [(W)98.9(elsh, Labbe, )19.1(V)66.3(itulli, & Kulkarni, 1992; Hatfield, )13.1(V)111.3(accaro, &)]TJ T* -0.0039 Tc [(Benedict, 1985; Hilyer)35.1(, )17.1(W)60.9(ilson, Dillon, & Caro, 1982; Percy)59.1(,)]TJ 0 -1.398 TD -0.0037 Tc 0.0307 Tw (Dziuban, & Marten, 1981\). For example, previous research)Tj 0 -1.401 TD -0.0031 Tc 0.09 Tw (has found physical exercise to be related to significant re-)Tj T* -0.045 Tw (ductions in depressive and anxiety symptomatology and sig-)Tj 0 -1.398 TD -0.0034 Tc -0.0189 Tw (nificant gains in self-esteem in children \(Brown et al., 1992;)Tj 0 -1.401 TD -0.0128 Tc -0.0617 Tw (Percy et al., 1981\).)Tj 1.8 -2.001 TD 0.0013 Tc 0.125 Tw [(T)72.1(wo studies have examined the relationship between)]TJ -1.8 -1.398 TD -0.007 Tc -0.0623 Tw [(physical exercise and PTSD symptomatology)62(, specifically)62(, in)]TJ 0 -1.401 TD -0.0081 Tc [(adults and children \(Manger)36.9(, 2000; Newman & Motta, 2007\).)]TJ T* -0.0038 Tc 0.0313 Tw (Manger \(2000\) examined the impact of aerobic exercise on)Tj ET endstream endobj 223 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 225 0 obj << /Length 9087 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.1063 Tw [(50 )]TJ /TT3 1 Tf 2.2463 0 TD -0.0054 Tc 0.107 Tw (Diaz and Motta Aerobic Exercise and Posttraumatic Stress)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0036 Tc 0.0757 Tw (PTSD in nine adult participants. The aerobic exercise pro-)Tj 0 -1.398 TD -0.0145 Tc -0.0623 Tw (gram involved walking and jogging on a treadmill for approxi-)Tj 0 -1.401 TD -0.0123 Tc [(mately 30 minutes, two or three times weekly)62.7(, for a period of 6)]TJ T* -0.0035 Tc 0.0825 Tw (to 10 weeks. Participation in the aerobic exercise program)Tj 0 -1.398 TD -0.0037 Tc -0.0217 Tw (was associated with significant reductions in reexperiencing)Tj 0 -1.401 TD -0.0032 Tc 0.0164 Tw [(symptom severity)62.8(, avoidance and numbing symptom sever)17.8(-)]TJ T* -0.0027 Tc 0.0806 Tw [(ity)60.3(, and hyperarousal symptom severity)63.3(. Significant reduc-)]TJ 0 -1.398 TD -0.0029 Tc 0.125 Tw (tion in depression and anxiety symptoms was also found.)Tj 0 -1.401 TD -0.0037 Tc 0.0866 Tw (These reductions were evident at post-treatment and on 1-)Tj T* -0.0042 Tc 0.0575 Tw (month follow-up assessment.)Tj 1.8 -1.998 TD -0.0037 Tc -0.0216 Tw (Although Manger \(2000\) found preliminary support for)Tj -1.8 -1.401 TD -0.0031 Tc -0.0625 Tw [(the efficacy of aerobic exercise in the treatment of PTSD, the)]TJ T* 0.0086 Tc 0.1247 Tw [(study)47.6(s weaknesses should not be overlooked. )20.3(These in-)]TJ 0 -1.398 TD -0.0036 Tc -0.0625 Tw (clude a high attrition rate; the original sample consisted of 26)Tj 0 -1.401 TD -0.0033 Tc -0.0335 Tw (participants, and only 9 completed the exercise intervention.)Tj T* -0.0032 Tc -0.0389 Tw (Also, treatment integrity is an area of concern. Manger com-)Tj 0 -1.398 TD -0.0003 Tc 0.125 Tw (pleted statistical analyses of the data on participants who)Tj 0 -1.401 TD -0.0038 Tc 0.0489 Tw (completed a minimum of 12 exercise sessions within a 10-)Tj T* -0.0034 Tc 0.0622 Tw (week period. Some variability was found in the number of)Tj 0 -1.398 TD -0.0009 Tc 0.125 Tw [(sessions completed among the participants. )53.1(Also, compli-)]TJ 0 -1.401 TD -0.0033 Tc 0.005 Tw (ance with the exercise program was assessed by self-report.)Tj 1.8 -2.001 TD -0.0038 Tc -0.0625 Tw (Newman and Motta \(2007\) investigated the effects of an)Tj -1.8 -1.398 TD -0.0037 Tc -0.0175 Tw (aerobic exercise program on childhood posttraumatic stress,)Tj 0 -1.401 TD -0.0029 Tc -0.0258 Tw [(depression, and anxiety)60.1(. )18(They found preliminary support for)]TJ T* -0.0035 Tc 0.02 Tw (aerobic exercise as a treatment intervention. Eleven adoles-)Tj 0 -1.398 TD -0.0076 Tc -0.0625 Tw (cent females from a residential treatment center completed an)Tj 0 -1.401 TD -0.0038 Tc -0.0492 Tw (8-week aerobic exercise program involving structured group)Tj T* -0.0034 Tc 0 Tw (exercises. Participation in the program led to significant de-)Tj 0 -1.398 TD -0.0033 Tc 0.05 Tw [(clines in posttraumatic stress, depression, and anxiety)59.7(.)0.3( Sig-)]TJ 0 -1.401 TD -0.0031 Tc 0.081 Tw (nificant reductions in psychological symptomatology were)Tj T* -0.0036 Tc -0.0238 Tw (noted mid-intervention after 4 weeks of the intervention had)Tj 0 -1.398 TD -0.0275 Tw (passed. Further significant reductions were noted at the con-)Tj 0 -1.401 TD -0.0037 Tc -0.062 Tw (clusion of the 8-week exercise program.)Tj 1.8 -2.001 TD -0.004 Tc -0.0625 Tw (The greatest weakness in the Newman and Motta \(2007\))Tj -1.8 -1.398 TD -0.0028 Tc 0.0439 Tw (study was variability among the types of exercise in which)Tj 0 -1.401 TD -0.0036 Tc 0.1136 Tw (the participants engaged. For example, some girls jogged,)Tj T* -0.0037 Tc -0.0272 Tw (whereas others completed kickboxing exercises. The lack of)Tj 0 -1.398 TD -0.0029 Tc -0.0367 Tw (uniformity is a concern.)Tj 1.8 -2.001 TD -0.0086 Tc -0.0625 Tw (It should be noted that currently no empirically grounded)Tj -1.8 -1.401 TD -0.0033 Tc 0.0222 Tw (explanation\(s\) exists for the psychological benefits of aero-)Tj 0 -1.398 TD -0.007 Tc -0.0625 Tw (bic exercise. 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The strengths of our)Tj T* -0.0031 Tc 0.0118 Tw (study include a fixed program schedule, a reward system to)Tj 0 -1.398 TD -0.0036 Tc -0.0586 Tw (manage possible attrition, and direct monitoring of treatment)Tj 0 -1.401 TD -0.0033 Tc 0.0659 Tw [(integrity and compliance by the principal investigator)50.7(. )14.9(The)]TJ T* 0.095 Tw (principal investigator hypothesized that participation in an)Tj 0 -1.398 TD -0.0036 Tc 0.04 Tw (aerobic exercise program would result in significant reduc-)Tj 0 -1.401 TD -0.0032 Tc 0.0956 Tw [(tions in PTSD symptom severity)62.8(, trauma-related stress se-)]TJ T* 0.0601 Tc 0.4909 Tw [(verity)66.1(, anxiety symptomatology)66.1(, and depressive)]TJ 0 -1.398 TD -0.0033 Tc -0.0585 Tw (symptomatology in a sample of institutionalized female ado-)Tj 0 -1.401 TD -0.0036 Tc 0.035 Tw [(lescents. )50.4(A)58.6( 1-month follow-up assessment of psychological)]TJ T* -0.0037 Tc 0.01 Tw (functioning was planned. Specific predictions regarding the)Tj 0 -1.398 TD -0.0084 Tc -0.0625 Tw (findings from the follow-up assessment were not made, given)Tj 0 -1.401 TD -0.0031 Tc 0.0462 Tw (the inconsistency of past research findings in this area.)Tj /F1 1 Tf 11 0 0 11 397.89 410.01 Tm -0.0047 Tc 0.141 Tw [( METHODS)]TJ -8.0809 -1.4564 TD 0.0003 Tc 0 Tw (Participants)Tj /TT2 1 Tf 10 0 0 10 327 370.65 Tm -0.0178 Tc -0.0622 Tw (Participants were recruited from a private residential treat-)Tj -1.8 -1.401 TD -0.0032 Tc 0.0741 Tw [(ment facility in )17.5(W)94.6(estchester County)62.8(, NY)125.8(. )17.5(The final sample)]TJ 0 -1.398 TD -0.0124 Tc -0.06 Tw (included 12)Tj /TT1 1 Tf 4.5 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.18 0 TD -0.012 Tc -0.0625 Tw (participants with ages ranging from 14 to 17 years)Tj -4.68 -1.401 TD 0 Tc 0 Tw (\()Tj /TT7 1 Tf 0.33 0 TD (M)Tj /TT2 1 Tf 0.825 0 TD -0.0027 Tc -0.0333 Tw [( = 15.42, )]TJ /TT7 1 Tf 3.69 0 TD -0.0061 Tc 0 Tw (SD )Tj /TT2 1 Tf 1.425 0 TD -0.0029 Tc -0.035 Tw (= .79\). Four girls identified their ethnicity as)Tj -6.27 -1.401 TD 0.0019 Tc 0.1251 Tw [(African )53(American, three girls identified their ethnicity as)]TJ 0 -1.398 TD -0.0123 Tc -0.0621 Tw (Latina, two girls identified their ethnicity as Caucasian/White,)Tj 0 -1.401 TD -0.0034 Tc -0.0522 Tw (two girls identified themselves as Biracial, and one girl iden-)Tj T* -0.0025 Tc -0.0305 Tw [(tified her ethnicity as Other)51.5(. )18.5(The length of stay at the facility)]TJ 0 -1.398 TD -0.0089 Tc -0.0617 Tw (ranged from 3 to 12 months \()Tj /TT7 1 Tf 11.106 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.819 0 TD -0.008 Tc -0.0617 Tw [( = 6, )]TJ /TT7 1 Tf 1.836 0 TD -0.0162 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.2 0 TD -0.0086 Tc -0.0629 Tw [( = 2.45\). )51.5(All 12 partici-)]TJ -14.961 -1.401 TD -0.0036 Tc 0.0479 Tw (pants received medical clearance for participation from the)Tj T* -0.0031 Tc -0.0578 Tw [(medical staf)17.9(f of the residential facility)59.9(.)]TJ 1.8 -1.998 TD 0.007 Tc 0.125 Tw (The current study would have been strengthened by)Tj -1.8 -1.401 TD -0.0037 Tc -0.0178 Tw [(knowledge of specific histories of trauma. However)35.3(, institu-)]TJ T* -0.0031 Tc 0.0018 Tw (tional guidelines of the residential facility prohibited the in-)Tj 0 -1.398 TD 0.0157 Tc 0.125 Tw (vestigator from obtaining information regarding trauma)Tj 0 -1.401 TD -0.005 Tc -0.062 Tw (histories, socioeconomic backgrounds, and current treatment)Tj T* 0.0078 Tc 0 Tw (plans.)Tj /F1 1 Tf 11 0 0 11 309 108 Tm -0.0049 Tc (Materials)Tj /TT2 1 Tf 10 0 0 10 327 84.66 Tm 0.0034 Tc 0.125 Tw (Materials included a demographics questionnaire, an)Tj -1.8 -1.401 TD -0.0214 Tc -0.0625 Tw (exercise history form, the Child PTSD Symptom Scale \(CPSS\),)Tj ET endstream endobj 226 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 228 0 obj << /Length 8972 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (51)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0037 Tc 0.12 Tw (the Trauma Symptom Checklist for Children \(TSCC\), the)Tj 0 -1.398 TD -0.0038 Tc 0.0536 Tw [(Multidimensional )50.5(Anxiety Scale for Children \(MASC\), the)]TJ 0 -1.401 TD -0.0035 Tc -0.0491 Tw [(Children)50.5(s Depression Inventory \(CDI\), a stopwatch, and in-)]TJ T* -0.0033 Tc -0.0192 Tw (dex cards for listing individual heart rates.)Tj 1.8 -1.998 TD -0.0039 Tc -0.0236 Tw (The Child PTSD Symptom Scale \(CPSS; Foa, Johnson,)Tj -1.8 -1.401 TD -0.0032 Tc 0.1055 Tw [(Feeny)62.8(, & )17.7(T)37.6(readwell, 2001\) is a self-report instrument that)]TJ T* -0.0042 Tc -0.0625 Tw (assesses the severity of PTSD symptoms in children between)Tj 0 -1.398 TD -0.0035 Tc -0.0555 Tw (the ages of 8 and 18. The 24-item scale assesses reexperienc-)Tj 0 -1.401 TD -0.0067 Tc -0.0622 Tw (ing, avoidance, and arousal symptoms \(Foa et al., 2001\). This)Tj T* -0.0035 Tc -0.0206 Tw (scale was created to reflect DSM-IV diagnostic criteria. The)Tj 0 -1.398 TD -0.0089 Tc -0.0622 Tw (first 17 items correspond directly with the 17 symptoms listed)Tj 0 -1.401 TD -0.0035 Tc -0.0219 Tw [(in the DSM-IV)125.5(, and the remaining 7 items assess daily func-)]TJ T* -0.0033 Tc 0.0405 Tw (tioning. The score derived from the first 17 items, the First)Tj 0 -1.398 TD -0.0031 Tc 0.1006 Tw [(T)73.7(otal Score, was used in statistical analyses in the current)]TJ 0 -1.401 TD -0.0036 Tc -0.0627 Tw [(study)65.4(. Overall PTSD symptom severity was assessed with 17)]TJ T* -0.0032 Tc -0.005 Tw (items on a four-point Likert-type scale, with a possible total)Tj 0 -1.398 TD -0.0033 Tc -0.0355 Tw (score of 51. Higher scores are indicative of greater symptom)Tj 0 -1.401 TD 0.0029 Tc 0 Tw [(severity)62.9(.)]TJ 1.8 -2.001 TD -0.0037 Tc -0.0286 Tw (Foa and colleagues \(2001\) reported the following infor-)Tj -1.8 -1.398 TD -0.0097 Tc -0.0622 Tw [(mation regarding scale reliability and validity)62.3(. Reported inter)14.3(-)]TJ 0 -1.401 TD -0.0032 Tc 0.0533 Tw (nal consistency of the cluster scores and total score ranged)Tj T* -0.0075 Tc -0.0623 Tw (between .70 and .89. The following coefficient alpha was cal-)Tj 0 -1.398 TD -0.0005 Tc 0.1249 Tw [(culated for the First )20.4(T)76.3(otal Score: .89. Reported test-retest)]TJ 0 -1.401 TD -0.0031 Tc 0.0225 Tw (reliability coefficients of the total and cluster scores ranged)Tj T* -0.003 Tc -0.0625 Tw [(between .63 and .85 \(Foa et al.\). Regarding scale validity)63(, the)]TJ 0 -1.398 TD -0.0019 Tc 0.125 Tw (total scale score correlated with the severity rating of the)Tj 0 -1.401 TD -0.0096 Tc -0.0624 Tw [(Children)50.4(s Posttraumatic S)14.4(tressReaction Index \(CPTSD-RI\))]TJ T* -0.0144 Tc -0.06 Tw (at .80.)Tj 1.8 -1.998 TD -0.0039 Tc 0.0792 Tw (The Trauma Symptom Checklist for Children \(TSCC;)Tj -1.8 -1.401 TD -0.0034 Tc 0.0756 Tw (Briere, 1996\) is a self-report instrument that assesses trau-)Tj T* -0.032 Tw (matic stress symptoms in children between the ages of 8 and)Tj 0 -1.398 TD -0.0066 Tc -0.0622 Tw (17 years. It assesses the following five dimensions of trauma-)Tj 0 -1.401 TD -0.0035 Tc 0.0086 Tw [(related stress in children: )53.5(Anxiety)59.5(, Depression, )50.5(Anger)35.5(, Post-)]TJ T* -0.0037 Tc -0.0225 Tw (traumatic Stress, and Dissociation. The Posttraumatic Stress)Tj 0 -1.398 TD -0.0034 Tc 0.0775 Tw (Scale assesses the frequency of intrusive thoughts and im-)Tj 0 -1.401 TD -0.0036 Tc 0.0956 Tw (ages, fears of men and women, and avoidance tendencies.)Tj T* -0.0034 Tc 0.0439 Tw (Unlike the CPSS, scale items do not correspond directly to)Tj 0 -1.398 TD -0.0036 Tc 0.0618 Tw (the DSM-IV criteria for PTSD. This scale assesses signifi-)Tj 0 -1.401 TD 0.0442 Tc 0.125 Tw (cantly more intrusive symptoms than avoidance and)Tj T* -0.0033 Tc -0.0133 Tw (hyperarousal symptoms. Respondents are instructed to indi-)Tj 0 -1.398 TD 0.0561 Tw (cate how often they think the described thought, engage in)Tj 0 -1.401 TD -0.0034 Tc -0.0445 Tw (the described action, or feel the described emotion on a four-)Tj T* -0.0032 Tc 0.0582 Tw [(point Likert-type scale. )17.7(The raw scores are converted to )17.7(T)91.6(-)]TJ 0 -1.398 TD 0.0969 Tw [(scores. In the current study)59.9(, data analyses were conducted)]TJ 0 -1.401 TD -0.0035 Tc 0.0174 Tw [(on the Posttraumatic S)14.5(tress Scale scores exclusively)62.5(.)]TJ 27.3 63.399 TD -0.0081 Tc -0.0625 Tw (Research indicates that the TSCC-A is reliable and valid.)Tj -1.8 -1.398 TD -0.0046 Tc -0.0622 Tw [(Briere \(1996\) )-5.8(reported the following information. In terms of)]TJ 0 -1.401 TD -0.0058 Tc -0.0627 Tw [(reliability)63.2(, the results of data gathered from the normalization)]TJ T* -0.0036 Tc 0.1041 Tw [(sample revealed high internal consistency)62.4(.)-5.4( )17.3(The normaliza-)]TJ 0 -1.398 TD 0.0962 Tw [(tion sample was a non-clinical sample consisting of 3,008)]TJ 0 -1.401 TD -0.0058 Tc -0.0622 Tw (children. The reported coefficient alpha for the Posttraumatic)Tj T* -0.0032 Tc 0.0942 Tw (Stress was .87. Information regarding test-retest reliability)Tj 0 -1.398 TD -0.0039 Tc -0.005 Tw (was unavailable.)Tj 1.8 -2.001 TD -0.0037 Tc 0.0175 Tw [(In terms of validity)59.3(,)-5.2( )17.3(TSCC results have been compared)]TJ -1.8 -1.401 TD -0.0038 Tc 0.0795 Tw [(to results obtained via completion of the )50.3(Achenbach Child)]TJ 0 -1.398 TD -0.0043 Tc -0.0257 Tw [(Behavior )-16.6(Checklist-Y)94.7(outh )-17.5(Self-Report. The TSCC )-16.2(Posttrau-)]TJ 0 -1.401 TD -0.0033 Tc 0.0225 Tw (matic Stress Scale was found to correlate significantly with)Tj T* -0.0036 Tc -0.0074 Tw [(the Internalizing Composite of the )32.5(Y)103.6(outh Self-Report at .75.)]TJ 0 -1.398 TD -0.0031 Tc 0.0012 Tw (This correlation was statistically significant.)Tj 1.8 -2.001 TD 0.0295 Tc 0.1251 Tw [(The Multidimensional )50.6(Anxiety Scale for Children)]TJ -1.8 -1.401 TD -0.0128 Tc -0.0625 Tw (\(MASC; March, 1997\) is a self-report instrument that assesses)Tj 0 -1.398 TD -0.0033 Tc -0.032 Tw (four dimensions of anxiety in children between the ages of 8)Tj 0 -1.401 TD -0.0028 Tc 0.0955 Tw (and 19 years. The four dimensions of anxiety assessed by)Tj T* -0.0033 Tc -0.0133 Tw (this measure include physical symptoms, avoidance tenden-)Tj 0 -1.398 TD -0.0392 Tw (cies, social discomfort, and separation fear/panic symptoms.)Tj 0 -1.401 TD -0.0034 Tc -0.02 Tw (Respondents are asked to indicate how often they have been)Tj T* -0.002 Tc 0.125 Tw (thinking the described thought, engaging in the described)Tj 0 -1.398 TD -0.0032 Tc 0.0378 Tw (action, or feeling the described emotion recently on a four-)Tj 0 -1.401 TD -0.0027 Tc 0.125 Tw (point Likert-type scale. The raw scores obtained on these)Tj T* -0.0036 Tc 0.0275 Tw [(scales were converted to )14.4(T)94.2(-scores. Completion of the entire)]TJ 0 -1.398 TD -0.0089 Tc -0.0622 Tw [(measure yields a )18.1(T)70.9(otal )51.1(Anxiety Scale score, a composite score)]TJ 0 -1.401 TD -0.0032 Tc 0.0485 Tw [(that reflects endorsement of multiple symptoms of anxiety)59.8(.)]TJ T* -0.0035 Tc 0.0632 Tw [(Changes in the )17.4(T)70.3(otal )53.4(Anxiety Scale were monitored in this)]TJ 0 -1.398 TD 0.0245 Tc 0 Tw [(study)63.5(.)]TJ 1.8 -2.001 TD -0.0033 Tc -0.0543 Tw (March \(1997\) reported the following scale reliability in-)Tj -1.8 -1.401 TD 0.0531 Tw (formation. The internal consistency of the scales was mea-)Tj 0 -1.398 TD -0.0117 Tc -0.0623 Tw [(sured with Cronbach)54.3(s alpha coef)15.3(ficient. )18.1(The reported internal)]TJ 0 -1.401 TD -0.0032 Tc -0.0027 Tw [(consistency of the )17.9(T)70.6(otal )50.9(Anxiety Scale was .878 for females)]TJ T* 0.0842 Tw [(and .888 for males. )14.7(T)73.6(est-retest reliability coef)17.8(ficients were)]TJ 0 -1.398 TD -0.0036 Tc 0.0514 Tw [(calculated based on 3-month follow-up testing. The coeffi-)]TJ 0 -1.401 TD -0.0057 Tc -0.0626 Tw [(cient for the )21.2(T)74.1(otal )54.2(Anxiety Scale was .933, which was statisti-)]TJ T* -0.0047 Tc -0.06 Tw (cally significant.)Tj 1.8 -1.998 TD -0.0075 Tc -0.0625 Tw (The following validity information is also reported in the)Tj -1.8 -1.401 TD -0.0037 Tc 0.1178 Tw (instrument manual \(March, 1997\). In terms of convergent)Tj T* -0.0029 Tc 0.0442 Tw [(validity)60.1(, the Physical Symptoms and Social )54(Anxiety Scales)]TJ 0 -1.398 TD -0.003 Tc 0.0883 Tw [(were found to be moderately to highly correlated with the)]TJ 0 -1.401 TD -0.0011 Tc 0.1251 Tw [(Revised Children)55.9(s Manifest )53(Anxiety Scale, a measure of)]TJ T* -0.0027 Tc -0.035 Tw [(worry)60.3(, fear)36.3(, and physiological symptoms of anxiety)63.3(. In addi-)]TJ 0 -1.398 TD -0.003 Tc 0.1157 Tw (tion, the Physical Symptoms Scale was moderately corre-)Tj 0 -1.401 TD -0.0113 Tc -0.0626 Tw [(lated with the Children)54.7(s Depression Inventory-Short. Finally)63.7(,)]TJ ET endstream endobj 229 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 231 0 obj << /Length 9023 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.1063 Tw [(52 )]TJ /TT3 1 Tf 2.2463 0 TD -0.0054 Tc 0.107 Tw (Diaz and Motta Aerobic Exercise and Posttraumatic Stress)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0034 Tc 0.0989 Tw (the parent and child reports on the MASC were analyzed,)Tj 0 -1.398 TD 0.0535 Tw (and significant correlations were found between the Physi-)Tj 0 -1.401 TD -0.0026 Tc 0.125 Tw [(cal Symptoms and Harm )51.4(A)80.6(voidance and Separation/Panic)]TJ T* -0.0049 Tc 0 Tw (Scales.)Tj 1.8 -1.998 TD 0.0182 Tc 0.1248 Tw [(Finally)63.2(,)0.2( the Children)48.2(s Depression Inventory \(CDI;)]TJ -1.8 -1.401 TD -0.0035 Tc 0.0028 Tw (Kovacs, 1992\) is a self-report instrument that assesses a va-)Tj T* -0.0027 Tc -0.0105 Tw (riety of depressive symptoms in children ages 7 to 17 years.)Tj 0 -1.398 TD -0.003 Tc 0.0813 Tw [(This scale yields six scores; however)36(, only the )18.2(T)73.8(otal score)]TJ 0 -1.401 TD -0.019 Tw [(was analyzed in this study)60(. Items are scored on a three-point)]TJ T* -0.0031 Tc 0.0988 Tw (Likert-type scale, and the total score can range between 0)Tj 0 -1.398 TD -0.0036 Tc -0.0188 Tw [(and 54. Raw scores are converted to )17.5(T)91.2(-scores. Higher scores)]TJ 0 -1.401 TD -0.0034 Tc 0.0187 Tw (are indicative of greater depression.)Tj 1.8 -2.001 TD -0.003 Tc -0.0014 Tw (The following reliability and validity information is re-)Tj -1.8 -1.398 TD -0.0035 Tc 0.0375 Tw (ported in the scale manual \(Kovacs, 1992\). Internal consis-)Tj 0 -1.401 TD -0.0029 Tc -0.0095 Tw (tency is good; it reportedly ranges between .71 and .89. The)Tj T* -0.0031 Tc 0.0269 Tw [(scale also possesses adequate test-retest reliability)59.9(, as it has)]TJ 0 -1.398 TD 0.0195 Tw (been found to range between .38 and .83. Studies with psy-)Tj 0 -1.401 TD 0.032 Tw (chiatric populations report test-retest reliability coefficients)Tj T* -0.0143 Tc -0.0622 Tw [(ranging between .5 and .87. Regarding scale validity)60.7(,)-5.8( )49(Asarnow)]TJ 0 -1.398 TD -0.0033 Tc 0.0294 Tw (and Carlson \(1985\) found that the scale significantly corre-)Tj 0 -1.401 TD -0.0035 Tc -0.0344 Tw (lated with the Depression Self Rating Scale at .81. Bodiford,)Tj T* -0.0034 Tc -0.01 Tw (Eisenstadt, Johnson, and Bradlyn \(1988\) found a significant)Tj 0 -1.398 TD -0.0037 Tc 0.0588 Tw (correlation between the CDI and the Depression and Inter-)Tj 0 -1.401 TD -0.0036 Tc -0.0517 Tw (nalizing scales of the Child Behavior Checklist.)Tj /F1 1 Tf 11 0 0 11 54 356.01 Tm 0.0039 Tc 0 Tw (Procedure)Tj /TT2 1 Tf 10 0 0 10 72 332.64 Tm -0.0031 Tc 0.125 Tw (The 12 participants who volunteered to participate in)Tj -1.8 -1.398 TD -0.0033 Tc 0.1022 Tw (the study completed a 5-week baseline period prior to the)Tj 0 -1.401 TD -0.0294 Tw (start of the exercise intervention. They completed the demo-)Tj T* -0.0035 Tc -0.035 Tw (graphics questionnaire, exercise history form, CPSS, TSCC,)Tj 0 -1.398 TD -0.0037 Tc -0.0156 Tw (MASC, and CDI during an initial baseline assessment at the)Tj 0 -1.401 TD -0.0034 Tc -0.0519 Tw (first week. Then, the participants completed the exercise his-)Tj T* -0.0032 Tc 0.0619 Tw (tory form and psychological measures at the conclusion of)Tj 0 -1.398 TD -0.0036 Tc -0.0275 Tw [(the 5-week baseline period. )50.4(After completion of the baseline)]TJ 0 -1.401 TD -0.045 Tw (period, all participants engaged in the exercise program. The)Tj T* -0.0039 Tc -0.053 Tw (intervention involved 25-minute sessions of moderate-inten-)Tj 0 -1.398 TD -0.0064 Tc -0.0625 Tw (sity aerobic exercise three times a week for a total of 5 weeks.)Tj 0 -1.401 TD -0.0038 Tc -0.0122 Tw [(Each 25-minute session was divided as follows: 1 minute of)]TJ T* -0.0036 Tc -0.0241 Tw [(slow)59.4(, leisurely walking \(warm-up\), 23 minutes of moderate-)]TJ 0 -1.398 TD -0.0031 Tc 0.0831 Tw [(intensity walking, and 1 minute of slow)62.9(, leisurely walking)]TJ 0 -1.401 TD -0.0035 Tc 0.1064 Tw (\(cool-down\). Participants measured their heart rates at the)Tj T* -0.0486 Tw (conclusion of the 12th minute of moderate-intensity walking)Tj 0 -1.398 TD -0.0032 Tc -0.0318 Tw (in each session in order to ensure that they fell between 60%)Tj 0 -1.401 TD -0.0036 Tc -0.0445 Tw (and 90% of their maximum heart rates. The examiner led the)Tj T* -0.0034 Tc 0.0972 Tw (group in all sessions, and all sessions were held outdoors.)Tj 25.5 64.2 TD -0.0038 Tc 0.0793 Tw (An additional assessment was conducted at the conclusion)Tj 0 -1.398 TD -0.0037 Tc 0.0708 Tw [(of the exercise program. )50.4(Again, the participants completed)]TJ 0 -1.401 TD -0.0031 Tc 0 Tw (the exercise history form and psychological measures.)Tj 1.8 -2.001 TD -0.004 Tc 0.0736 Tw (A follow-up assessment was conducted 1 month post-)Tj -1.8 -1.398 TD -0.0038 Tc 0.0515 Tw (intervention. The purpose of the follow-up assessment was)Tj 0 -1.401 TD -0.0033 Tc 0.0156 Tw (to explore whether or not significant gains in psychological)Tj T* -0.0036 Tc -0.0094 Tw (functioning had been maintained for at least 1 month. Three)Tj 0 -1.398 TD -0.003 Tc 0.0915 Tw (participants remained in the facility at the time, and all of)Tj 0 -1.401 TD -0.0033 Tc -0.035 Tw (them completed the exercise history form and psychological)Tj T* 0.0005 Tc 0 Tw (measures.)Tj /F1 1 Tf 11 0 0 11 309 558 Tm -0.0052 Tc 0.05 Tw (Data Analysis)Tj /TT2 1 Tf 10 0 0 10 327 534.66 Tm -0.0031 Tc 0.0322 Tw (Participants met specific eligibility criteria in order for)Tj -1.8 -1.401 TD 0.0027 Tc 0.125 Tw (their data to be included in statistical analyses. First, the)Tj T* -0.0037 Tc 0.0106 Tw (CPSS score obtained during the initial screening equaled or)Tj 0 -1.398 TD -0.0143 Tc -0.0625 Tw (exceeded a predetermined cut-off score of 11. Foa et al. \(2001\))Tj 0 -1.401 TD -0.0036 Tc -0.0085 Tw (found that a score of 11 on the CPSS differentiated between)Tj T* -0.0038 Tc 0.0357 Tw (low and high symptoms of traumatic stress on the CPSTD-)Tj 0 -1.398 TD -0.0033 Tc -0.0515 Tw [(R)6.7(I)-3.3(, the most widely used measure in the assessment of child-)]TJ 0 -1.401 TD -0.0068 Tc -0.0624 Tw [(hood trauma symptoms \(McNally)65.2(, 1991\).)]TJ 1.8 -2.001 TD -0.0034 Tc 0.0533 Tw [( Second, the investigator intended to exclude the data)]TJ -1.8 -1.398 TD -0.0033 Tc -0.0166 Tw [(of children who reported that they engaged in regular)38.7(, rigor)14.7(-)]TJ 0 -1.401 TD -0.0029 Tc 0.1189 Tw (ous physical activity for at least a 20-minute period three)Tj T* -0.0031 Tc 0.1166 Tw [(times or more weekly throughout the course of the study)59.9(.)]TJ 0 -1.398 TD -0.0033 Tc 0.0188 Tw [(None of the participants reported such an activity schedule,)]TJ 0 -1.401 TD -0.0035 Tc 0.0232 Tw (and thus no data were excluded for this reason.)Tj 1.8 -2.001 TD -0.0037 Tc 0.077 Tw (Given the small sample size \()Tj /TT7 1 Tf 12.084 0 TD -0.008 Tc 0 Tw (N )Tj /TT2 1 Tf 0.987 0 TD -0.0035 Tc 0.0775 Tw (= 12\), changes on the)Tj -14.871 -1.398 TD -0.0038 Tc -0.0226 Tw [(CPSS, the Posttraumatic S)17.2(tress Scale of the )17.4(TSCC, the )14.4(T)73(otal)]TJ 0 -1.401 TD -0.0036 Tc -0.0254 Tw [(Anxiety Scale of the MASC, and the )14.6(T)73.2(otal Depression Scale)]TJ T* -0.0195 Tw (of the CDI were examined over time via a statistical method)Tj 0 -1.398 TD 0.0335 Tw [(developed by )32.4(Y)103.7(arnold \(1988\) for single-case repeated mea-)]TJ 0 -1.401 TD -0.0259 Tw [(sures designs. )32.8(Y)103.7(arnold)50.5(s method can be employed in statisti-)]TJ T* 0.0048 Tc 0.125 Tw (cal examinations of studies involving a small number of)Tj 0 -1.398 TD 0.0228 Tc 0.1251 Tw [(repeated observations. Using )34.9(Y)100(arnold)52.8(s approach, each)]TJ 0 -1.401 TD -0.0035 Tc 0.1207 Tw [(participant)53.5(s score on each dependent variable at each as-)]TJ T* 0.0127 Tw [(sessment point was converted to an ipsative z-score. )17.4(T)73.3(o)-0.4( test)]TJ 0 -1.398 TD -0.0031 Tc 0.0414 Tw (for statistically significant changes in scores, the investiga-)Tj 0 -1.401 TD -0.0035 Tc 0.0043 Tw (tor calculated the absolute difference between two z-scores.)Tj T* 0.0656 Tw (This absolute difference was then compared with a critical)Tj 0 -1.398 TD -0.0034 Tc 0.0756 Tw (difference score for each participant on each variable. The)Tj 0 -1.401 TD -0.01 Tc -0.0625 Tw (following formula was used to calculate the critical difference)Tj T* -0.0034 Tc -0.0185 Tw (score for each participant on each variable: CD = 1.64 [)Tj /TT7 1 Tf 21.876 0 TD 0 Tc 0 Tw (J)Tj /TT2 1 Tf 0.438 0 TD -0.0033 Tc -0.02 Tw (\(1 -)Tj -22.314 -1.398 TD -0.0032 Tc 0.0263 Tw (reliability coefficient for the measure\)])Tj 5.8 0 0 5.8 464.25 105.99 Tm -0.0001 Tc 0 Tw (1/2)Tj 10 0 0 10 471.66 102.66 Tm -0.0029 Tc 0.0262 Tw (. In this formula, )Tj /TT7 1 Tf 6.993 0 TD 0 Tc 0 Tw (J)Tj /TT2 1 Tf -23.259 -1.401 TD -0.0036 Tc -0.0306 Tw (refers to the number of comparisons conducted for each par-)Tj T* -0.0031 Tc 0 Tw (ticipant. )Tj /TT7 1 Tf 3.486 0 TD 0 Tc (J)Tj /TT2 1 Tf 0.438 0 TD -0.0036 Tc 0.015 Tw [( corrects for the number of comparisons made for)]TJ ET endstream endobj 232 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 234 0 obj << /Length 9083 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (53)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0031 Tc 0.0728 Tw (each participant by increasing the critical difference score.)Tj 0 -1.398 TD -0.0034 Tc 0.1068 Tw (This increase makes it more difficult to achieve statistical)Tj 0 -1.401 TD -0.0047 Tc 0 Tw (significance.)Tj 1.8 -2.001 TD -0.0095 Tc -0.0625 Tw (If the absolute difference between two scores was greater)Tj -1.8 -1.398 TD -0.0034 Tc -0.0138 Tw (than the critical difference score, the change between scores)Tj 0 -1.401 TD -0.0032 Tc 0.0533 Tw (was deemed statistically significant. The critical difference)Tj T* -0.0034 Tc -0.006 Tw (scores had an overall p )Tj ET 0.54 w 164.52 631.66 m 159.06 631.66 l S BT /F25 1 Tf 10 0 0 10 159.06 632.64 Tm 0 Tc 0 Tw (<)Tj ET 500 w 166.89 -367.36 m 164.49 -367.36 l S BT /TT2 1 Tf 10 0 0 10 164.49 632.64 Tm -0.0029 Tc -0.007 Tw [( .05 for a one-tailed test.)]TJ -8.049 -1.998 TD -0.0027 Tc -0.0486 Tw [(The reliability coefficient is the test-retest reliability co-)]TJ -1.8 -1.401 TD 0.0001 Tc 0.1253 Tw [(ef)18.1(ficient for each dependent measure. Originally)66.1(,)-4.9( )30.4(Y)107.3(arnold)]TJ T* -0.0037 Tc 0.04 Tw (\(1988\) explained that lag-1 autocorrelations should be sub-)Tj 0 -1.398 TD -0.0084 Tc -0.0622 Tw [(tracted from 1 in the formula. However)36.6(, Mueser)36.6(, )30.6(Y)104.8(arnold, and)]TJ 0 -1.401 TD -0.0035 Tc -0.0256 Tw (Foy \(1991\) clarified the method and recommended that test-)Tj T* -0.0034 Tc 0.0243 Tw (retest reliabilities be used rather than lag-1 autocorrelations)Tj 0 -1.398 TD -0.0037 Tc 0.1158 Tw (to estimate the expected autocorrelation among sequential)Tj 0 -1.401 TD -0.0033 Tc 0.0187 Tw (values when the number of observations is relatively small,)Tj T* -0.0034 Tc -0.0243 Tw [(as is the case in the current study)59.6(. On the CPSS, MASC, and)]TJ 0 -1.398 TD -0.0032 Tc -0.0156 Tw (CDI, the test-retest reliability scores were obtained from the)Tj 0 -1.401 TD -0.0037 Tc 0.1005 Tw (scale manuals. The TSCC test manual did not report such)Tj T* -0.0031 Tc 0.0571 Tw (data; thus, the test-retest reliability score obtained between)Tj 0 -1.398 TD -0.0034 Tc 0.0167 Tw (the baseline assessment points in the current study was em-)Tj 0 -1.401 TD -0.0055 Tc -0.061 Tw (ployed, r = 0.89, p )Tj ET 0.54 w 143.55 429.67 m 138.09 429.67 l S BT /F25 1 Tf 10 0 0 10 138.09 430.65 Tm 0 Tc 0 Tw (<)Tj ET 500 w 145.41 -569.35 m 143.55 -569.35 l S BT /TT2 1 Tf 10 0 0 10 143.55 430.65 Tm -0.0065 Tc -0.0575 Tw [( )7.5(.05.)]TJ -5.955 -2.001 TD 0.0043 Tc 0.125 Tw (For all participants, the investigator began statistical)Tj -1.8 -1.398 TD -0.0031 Tc 0.0394 Tw (analyses by comparing the two baseline scores on each de-)Tj 0 -1.401 TD -0.0036 Tc -0.0206 Tw (pendent measure. If the absolute difference between the two)Tj T* -0.0033 Tc 0.0206 Tw (baseline z-scores was less than the critical difference score,)Tj 0 -1.398 TD -0.0035 Tc 0.1039 Tw (the average of the two baseline scores was calculated and)Tj 0 -1.401 TD -0.0015 Tc 0.125 Tw (used for the remainder of the z-score comparisons. If the)Tj T* -0.0037 Tc 0.0872 Tw (absolute difference between the two baseline z-scores was)Tj 0 -1.398 TD -0.0033 Tc -0.035 Tw (greater than the critical difference score, further calculations)Tj 0 -1.401 TD 0.0121 Tc 0.125 Tw (were not conducted, as there was no evidence of stable)Tj T* -0.0038 Tc -0.0625 Tw [(baseline levels of symptomatology)62.2(. Kazdin \(1998\) explained)]TJ 0 -1.398 TD -0.0034 Tc 0.1039 Tw (that a stable baseline provides a clear basis for evaluating)Tj 0 -1.401 TD -0.0037 Tc -0.0349 Tw [(the ef)17.3(fects of an intervention on an individual)50.3(s performance)]TJ T* -0.0038 Tc 0.035 Tw (or functioning.)Tj 1.8 -1.998 TD -0.0034 Tc 0.0122 Tw (For the majority of participants, two comparisons were)Tj -1.8 -1.401 TD -0.0037 Tc 0.0619 Tw (made on each dependent variable. The two baseline scores)Tj T* -0.0036 Tc 0.0072 Tw [(were compared with each other)38.4(, and the average baseline z-)]TJ 0 -1.398 TD -0.0037 Tc 0.0279 Tw (score was compared with the post-intervention z-score. For)Tj 0 -1.401 TD -0.0038 Tc -0.0229 Tw (the three participants who completed the 1-month follow-up)Tj T* -0.0035 Tc -0.0021 Tw (assessment, four comparisons were generally made. The in-)Tj 0 -1.398 TD 0.002 Tc 0.125 Tw (vestigator compared the two baseline scores, the average)Tj 0 -1.401 TD -0.0034 Tc 0.1064 Tw (baseline z-score to the post-intervention z-score, the aver-)Tj T* 0.0394 Tw (age baseline z-score to the follow-up z-score, and the post-)Tj 0 -1.398 TD -0.0035 Tc -0.008 Tw (intervention z-score to the follow-up z-score.)Tj /F1 1 Tf 11 0 0 11 413.64 723.99 Tm 0.0198 Tc 0 Tw [(RESUL)82.5(TS)]TJ /TT2 1 Tf 10 0 0 10 339 700.65 Tm -0.0036 Tc 0.0186 Tw (It was expected that participants would experience sig-)Tj -1.8 -1.401 TD -0.0033 Tc 0.0564 Tw [(nificant reductions in PTSD symptom severity)62.7(, as assessed)]TJ 0 -1.398 TD 0.0256 Tw (by the CPSS, following participation in an aerobic exercise)Tj 0 -1.401 TD -0.0045 Tc -0.0625 Tw [(program as compared to baseline levels of symptom severity)58.5(.)]TJ T* -0.0036 Tc -0.014 Tw (Eleven of the 12 participants showed a stable level of PTSD)Tj 0 -1.398 TD -0.0032 Tc -0.0422 Tw [(symptomatology across the extended baseline period. )17.7(T)73.6(en of)]TJ 0 -1.401 TD -0.0036 Tc 0.1158 Tw (these 11 participants experienced significant reductions in)Tj T* -0.0143 Tc -0.0621 Tw (PTSD following participation in the aerobic exercise program.)Tj 0 -1.398 TD -0.003 Tc 0.0993 Tw (Of these 10, 9 participants levels of symptomatology fell)Tj 0 -1.401 TD -0.0036 Tc 0.1038 Tw (from the high-level range of PTSD to the low-level range)Tj T* 0.0436 Tw (following participation in the aerobic exercise program. Of)Tj 0 -1.398 TD -0.0038 Tc -0.0229 Tw (the three participants who completed the 1-month follow-up)Tj 0 -1.401 TD -0.0032 Tc -0.0471 Tw (assessment, all three reported significantly less PTSD symp-)Tj T* -0.0034 Tc 0.0188 Tw (tomatology at the follow-up, in comparison to baseline lev-)Tj 0 -1.398 TD -0.0035 Tc 0.0016 Tw [(els. )50.6(A)58.7( significant dif)14.5(ference was found for one of these girls)]TJ 0 -1.401 TD -0.0625 Tw (in PTSD symptomatology between post-intervention and the)Tj T* -0.016 Tc 0 Tw (follow-up.)Tj 1.8 -1.998 TD -0.0036 Tc -0.005 Tw (It was predicted that participants would experience sig-)Tj -1.8 -1.401 TD -0.0032 Tc 0.1057 Tw [(nificant reductions in trauma-related stress severity)62.8(, as as-)]TJ T* 0.0205 Tc 0.125 Tw (sessed by the Posttraumatic Stress Scale of the TSCC,)Tj 0 -1.398 TD -0.0157 Tc -0.0625 Tw (following participation in an aerobic exercise program as com-)Tj 0 -1.401 TD -0.0031 Tc -0.0135 Tw [(pared to baseline levels of symptom severity)59.9(. Nine of the 12)]TJ T* -0.0035 Tc 0.1185 Tw (participants showed a stable level of trauma-related stress)Tj 0 -1.398 TD 0.0089 Tw (across the extended baseline period. Six of the nine demon-)Tj 0 -1.401 TD -0.0033 Tc -0.0272 Tw (strated a significant reduction in PTSD symptomatology be-)Tj T* 0.0396 Tc 0.1249 Tw [(tween baseline and post-intervention. Clinically)60.6(, one)]TJ 0 -1.398 TD -0.0035 Tc -0.062 Tw [(participant)53.5(s score fell from the clinically significant range)]TJ 0 -1.401 TD 0.083 Tw [(to the at risk range, one participant)50.5(s score fell from the)]TJ T* -0.0069 Tc -0.0625 Tw (clinically significant range to the average range, and four)Tj 0 -1.398 TD -0.0036 Tc -0.0395 Tw (participants scores fell from the at risk range to the aver-)Tj 0 -1.401 TD -0.0004 Tw [(age range. )50.5(All three of the girls who completed the follow-)]TJ T* -0.0031 Tc 0.125 Tw (up assessment reported significantly less symptomatology)Tj 0 -1.398 TD -0.0036 Tc 0.0744 Tw [(at the follow-up in comparison to the baseline. )17.3(T)70.2(wo of the)]TJ 0 -1.401 TD -0.0018 Tc 0.125 Tw (three girls showed significant reductions in symptomatol-)Tj T* -0.0035 Tc 0.0562 Tw (ogy between post-intervention and follow-up.)Tj 1.8 -1.998 TD 0.0186 Tw (It was expected that participants would experience sig-)Tj -1.8 -1.401 TD -0.003 Tc 0.0499 Tw [(nificant reductions in anxiety symptomatology)63(, as assessed)]TJ T* -0.0072 Tc -0.0622 Tw [(by the )16.8(T)69.6(otal )52.8(Anxiety Scale of the MASC, following participa-)]TJ 0 -1.398 TD -0.0036 Tc -0.0061 Tw (tion in an aerobic exercise program as compared to baseline)Tj 0 -1.401 TD -0.0057 Tc -0.0622 Tw [(levels of symptom severity)60.3(. Six of the 12 participants showed)]TJ T* -0.0032 Tc -0.0294 Tw [(a stable level of anxiety across the extended baseline period.)]TJ 0 -1.398 TD -0.0035 Tc 0.0037 Tw (Three of the six demonstrated significant reductions in total)Tj 0 -1.401 TD -0.0034 Tc 0.0258 Tw (anxiety between the baseline and post-intervention periods.)Tj T* -0.0032 Tc -0.0061 Tw [(T)73.6(wo of these three participants were the only participants in)]TJ ET endstream endobj 235 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F25 236 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 238 0 obj << /Length 7807 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.1063 Tw [(54 )]TJ /TT3 1 Tf 2.2463 0 TD -0.0054 Tc 0.107 Tw (Diaz and Motta Aerobic Exercise and Posttraumatic Stress)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0026 Tc 0.125 Tw (the sample to demonstrate above-average levels of symp-)Tj 0 -1.398 TD -0.0039 Tc -0.0622 Tw (tomatology during the baseline period. Of the three girls who)Tj 0 -1.401 TD -0.0037 Tc 0.12 Tw (completed the follow-up assessment, one reported signifi-)Tj T* 0.0019 Tc 0.125 Tw (cantly less anxiety at the follow-up in comparison to the)Tj 0 -1.398 TD -0.0036 Tc -0.035 Tw (baseline period. This participant showed a significant reduc-)Tj 0 -1.401 TD -0.0034 Tc 0.0179 Tw [(tion in anxiety between post-intervention and follow-up. )50.6(A)6.6(t)]TJ T* -0.0033 Tc 0.0258 Tw [(the follow-up assessment, one participant)53.7(s level of anxiety)]TJ 0 -1.398 TD -0.0035 Tc -0.0005 Tw (had returned to below average, which was the level of anxi-)Tj 0 -1.401 TD -0.003 Tc 0.0305 Tw [(ety observed for her during the baseline phase of the study)60(.)]TJ 1.8 -2.001 TD -0.0033 Tc -0.0022 Tw [(Finally)62.7(, it was predicted that participants would experi-)]TJ -1.8 -1.398 TD -0.0034 Tc 0.102 Tw [(ence significant reductions in depressive symptomatology)59.6(,)]TJ 0 -1.401 TD -0.0032 Tc 0.0249 Tw [(as assessed by the Depressive Symptoms )17.7(T)70.6(otal Scale of the)]TJ T* -0.0036 Tc -0.0115 Tw [(CDI, following participation in an aerobic exercise program)]TJ 0 -1.398 TD -0.0032 Tc -0.0483 Tw [(as compared to baseline levels of symptom severity)59.8(. Eight of)]TJ 0 -1.401 TD -0.0034 Tc 0.0019 Tw (the 12 reported stable levels of depressive symptoms across)Tj T* -0.0036 Tc -0.0368 Tw [(the extended baseline period. )17.5(T)73.2(wo of these eight participants)]TJ 0 -1.398 TD -0.0034 Tc -0.025 Tw (reported a significant reduction in depressive symptoms fol-)Tj 0 -1.401 TD -0.0035 Tc -0.055 Tw (lowing participation in the aerobic exercise program. The re-)Tj T* -0.0033 Tc 0.1084 Tw [(ductions were also clinically significant. One participant)50.7(s)]TJ 0 -1.398 TD -0.0031 Tc -0.0545 Tw (level of total anxiety fell from very much above average to)Tj 25.5 27.198 TD -0.0029 Tc 0.125 Tw [(slightly above average, one participant)51.1(s level fell from)]TJ 0 -1.398 TD -0.0038 Tc 0.0007 Tw (much above average to slightly above average, and one)Tj 0 -1.401 TD -0.0037 Tc 0.0907 Tw [(participant)53.3(s level from average to slightly below aver)14.3(-)]TJ T* 0.0046 Tc 0 Tw (age.)Tj 1.8 -1.998 TD -0.0036 Tc 0.0339 Tw [(T)73.2(wo of the three girls who completed the 1-month fol-)]TJ -1.8 -1.401 TD 0.0064 Tw (low-up assessment had demonstrated stable levels of symp-)Tj T* -0.0054 Tc -0.0625 Tw (tomatology across the extended baseline period. One of these)Tj 0 -1.398 TD -0.0032 Tc -0.0541 Tw (two participants reported significantly less depressive symp-)Tj 0 -1.401 TD -0.0095 Tc -0.0622 Tw (tomatology at the 1-month follow-up than she had at baseline.)Tj 1.8 -2.001 TD -0.0033 Tc 0.0789 Tw [(Please refer to )17.6(T)73.5(ables 1 through 4 for z-score data for)]TJ -1.8 -1.398 TD -0.0035 Tc 0.0793 Tw (each participant on each dependent variable across the ex-)Tj 0 -1.401 TD 0.007 Tc 0.125 Tw [(tended baseline phase of the study)61(. Post-intervention as-)]TJ T* -0.0092 Tc -0.0625 Tw (sessment z-score data are also presented for those participants)Tj 0 -1.398 TD -0.0037 Tc -0.0306 Tw (who demonstrated stable levels of functioning on the depen-)Tj 0 -1.401 TD 0.0872 Tw (dent variable measures across the extended baseline phase)Tj T* -0.0043 Tc -0.0625 Tw [(of the study)58.7(. Finally)61.7(, follow-up data are also presented for the)]TJ 0 -1.398 TD -0.0037 Tc 0.0883 Tw (participants who demonstrated stable levels of functioning)Tj 0 -1.401 TD 0.1206 Tw (on the dependent variable measures and completed the 1-)Tj T* -0.0042 Tc 0.0575 Tw (month follow-up assessment.)Tj /TT3 1 Tf -2.961 -5.064 TD -0.0067 Tc -0.07 Tw (Table 1)Tj -13.05 -1.2 TD -0.0049 Tc -0.0041 Tw (Z-score Data and the First Total of the Child PTSD Symptom Scale)Tj 13.011 -1.2 TD -0.0178 Tc 0 Tw (\(CPSS\))Tj ET 0.676 0.66 0.602 rg /GS1 gs 79.5 372.99 432 -1.5 re f 500 w /GS2 gs 146.49 -640 m 99.99 -640 l S BT 10 0 0 10 99.99 360 Tm 0 0 0 1 k -0.0075 Tc (Participant)Tj ET 204.99 -640 m 189.99 -640 l S BT 10 0 0 10 189.99 360 Tm -0.008 Tc 0.015 Tw [( B1)-6008( )]TJ ET 279.99 -640 m 267.9 -640 l S BT 10 0 0 10 267.9 360 Tm -0.0141 Tc 0 Tw (B2)Tj ET 334.59 -640 m 327.99 -640 l S BT 10 0 0 10 327.99 360 Tm 0 Tc (B)Tj ET 406.74 -640 m 396.99 -640 l S BT 10 0 0 10 396.99 360 Tm 0.0302 Tc (PI)Tj ET 475.74 -640 m 462.99 -640 l S BT 10 0 0 10 462.99 360 Tm -0.058 Tc (FU)Tj -36.3 -1.401 TD -0.0201 Tc [(A)-8353.1(.87)-6170.1(.87)-4670.1(.87)]TJ /F1 1 Tf 29.4 0 TD -0.0243 Tc [(-.87)-4974.3(-.87)]TJ /TT3 1 Tf -29.4 -1.5 TD -0.0201 Tc 0.0141 Tw [(B)-8353.1(.87)-6170.1(.87)-4370.1( .)-14.1(8)-14.1(7)]TJ /F1 1 Tf 29.4 0 TD -0.0243 Tc 0 Tw [(-.87)-4974.3(-.87)]TJ /TT3 1 Tf -29.4 -1.5 TD -0.0201 Tc [(C)-8297.9(.63)-6170.1(.52)-4670.1(.58)]TJ /F1 1 Tf 28.875 0 TD -0.026 Tc (-1.15)Tj /TT3 1 Tf 2.181 0 TD 0.0207 Tc ( )Tj -31.056 -1.5 TD -0.0201 Tc [(4)-8463.9(.49)-6170.1(.66)-4670.1(.58)]TJ /F1 1 Tf 28.875 0 TD -0.026 Tc (-1.15)Tj /TT3 1 Tf 2.181 0 TD 0.0207 Tc ( )Tj -31.056 -1.5 TD -0.0201 Tc [(5)-8463.9(.10)-6170.1(.95)-4670.1(.52)]TJ /F1 1 Tf 28.875 0 TD -0.026 Tc (-1.05)Tj /TT3 1 Tf 2.181 0 TD 0.0207 Tc ( )Tj -31.056 -1.5 TD -0.0241 Tc 0.0449 Tw [(6)-8167.9(-.12)-5649.1(1.05)-30.1( )-30.1( )-27.1( )]TJ T* -0.0201 Tc 0 Tw [(7)-8463.9(.52)-6170.1(.71)-4670.1(.62)-5870.1(.24)]TJ /F1 1 Tf 35.475 0 TD -0.026 Tc (-1.47)Tj /TT3 1 Tf -35.475 -1.5 TD -0.0201 Tc [(8)-8463.9(.73)-6170.1(.41)-4670.1(.57)]TJ /F1 1 Tf 28.875 0 TD -0.026 Tc (-1.14)Tj /TT3 1 Tf 2.181 0 TD 0.0207 Tc ( )Tj -31.056 -1.5 TD -0.0201 Tc [(9)-8463.9(.65)-6170.1(.51)-4670.1(.58)]TJ /F1 1 Tf 28.875 0 TD -0.026 Tc (-1.15)Tj /TT3 1 Tf 2.181 0 TD 0.0207 Tc ( )Tj -31.056 -1.5 TD -0.0201 Tc [(1)42.2(0)-7970.1(.58)-6170.1(.58)-4670.1(.58)]TJ /F1 1 Tf 28.875 0 TD -0.026 Tc (-1.15)Tj /TT3 1 Tf 2.181 0 TD 0.0207 Tc ( )Tj -31.056 -1.5 TD -0.0201 Tc [(1)42.2(1)-7970.1(.45)-6170.1(.)-11.1(7)-5195.1(.57)]TJ /F1 1 Tf 28.875 0 TD -0.026 Tc (-1.15)Tj /TT3 1 Tf 2.181 0 TD 0.0207 Tc ( )Tj -31.056 -1.5 TD -0.0201 Tc [(1)42.2(2)-7970.1(.53)-6170.1(.62)-4670.1(.58)]TJ /F1 1 Tf 28.875 0 TD -0.026 Tc (-1.15)Tj /TT3 1 Tf 2.181 0 TD 0.0207 Tc ( )Tj /F19 1 Tf 10 0 2.1256 10 78.99 144 Tm -0.0049 Tc -0.0012 Tw (Note: B1 = Baseline 1/ First Assessment; 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It was predicted that participants)Tj 0 -1.401 TD -0.0038 Tc 0.04 Tw [(would experience significant reductions in PTSD symptom)]TJ T* -0.0033 Tc 0.0222 Tw (severity following participation in the aerobic exercise pro-)Tj 0 -1.398 TD -0.0031 Tc 0.0471 Tw (gram. The majority of participants showed statistically and)Tj 0 -1.401 TD 0.114 Tw (clinically significant reductions in PTSD symptomatology)Tj T* -0.0038 Tc -0.0137 Tw [(from baseline to post-intervention on the CPSS. )-6.9(Our current)]TJ 0 -1.398 TD -0.0132 Tc -0.0621 Tw (results are fairly consistent with previous preliminary research)Tj 0 -1.401 TD -0.0026 Tc 0.0965 Tw [(in the area of PTSD and physical activity)63.4(, specifically the)]TJ T* -0.0038 Tc -0.0217 Tw (results of Manger \(2000\) and Newman and Motta \(2007\). 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These results again are consistent)Tj T* -0.0053 Tc -0.0622 Tw (with those of Manger \(2000\) and Newman and Motta \(2007\).)Tj 0 -1.398 TD -0.0028 Tc 0.0798 Tw [(Clearly)63.2(, the results of this study add further support to the)]TJ 0 -1.401 TD -0.0035 Tc -0.0564 Tw (growing body of research documenting the beneficial effects)Tj T* -0.017 Tw (of aerobic exercise on trauma survivors.)Tj 1.8 -1.998 TD -0.0017 Tc 0.1249 Tw [(It is noteworthy that the results of the CPSS provide)]TJ -1.8 -1.401 TD -0.0035 Tc 0.0122 Tw (stronger support than the TSCC for the beneficial effects of)Tj T* -0.0031 Tc 0.0592 Tw [(aerobic exercise on PTSD symptomatology)62.9(, specifically as)]TJ 0 -1.398 TD -0.0034 Tc 0.125 Tw [(per the DSM-IV)86.6(-TR. )17.6(The dif)17.6(ferences in the scores on the)]TJ 0 -1.401 TD -0.0095 Tc -0.0625 Tw (CPSS and TSCC may be attributed to differences in the speci-)Tj T* -0.0157 Tc -0.0626 Tw [(ficity of the items. Generally)65.3(, the CPSS items are more specific)]TJ 0 -1.398 TD -0.0032 Tc 0.055 Tw (and descriptive than the TSCC items; such specificity may)Tj 0 -1.401 TD -0.003 Tc 0.044 Tw (lead to greater sensitivity to change.)Tj 1.8 -2.001 TD -0.0033 Tc 0.07 Tw (Three of the six participants demonstrated statistically)Tj -1.8 -1.398 TD -0.0171 Tw (significant reductions in total anxiety following the exercise)Tj 0 -1.401 TD -0.0036 Tc 0.0375 Tw (intervention. One participant demonstrated a significant in-)Tj T* -0.0033 Tc 0.0693 Tw (crease in total anxiety between baseline and post-interven-)Tj 0 -1.398 TD -0.0035 Tc 0.0881 Tw [(tion. )17.5(The reason behind the significant increase is unclear)50.5(.)]TJ 0 -1.401 TD 0.0004 Tc 0.1253 Tw [(However)39.4(, although a statistically significant increase was)]TJ /TT3 1 Tf -3.21 63.135 TD -0.0067 Tc -0.07 Tw (Table 4)Tj -14.439 -1.2 TD -0.0049 Tc -0.0404 Tw (Z-score Data and the Total Depression Scale of the Childrens Depression)Tj 12.75 -1.2 TD -0.0078 Tc -0.07 Tw (Inventory \(CDI\))Tj ET 0.676 0.66 0.602 rg /GS1 gs 77.01 678.99 432 -1.5 re f 500 w /GS2 gs 144 -334.66 m 97.5 -334.66 l S BT 10 0 0 10 97.5 665.34 Tm 0 0 0 1 k -0.0075 Tc 0 Tw (Participant)Tj ET 199.5 -334.66 m 187.5 -334.66 l S BT 10 0 0 10 187.5 665.34 Tm -0.0231 Tc (B1)Tj ET 274.5 -334.66 m 262.5 -334.66 l S BT 10 0 0 10 262.5 665.34 Tm [(B2)-5123.1( )]TJ ET 335.25 -334.66 m 328.65 -334.66 l S BT 10 0 0 10 328.65 665.34 Tm 0 Tc (B)Tj ET 404.25 -334.66 m 394.5 -334.66 l S BT 10 0 0 10 394.5 665.34 Tm 0.0302 Tc -0.0334 Tw [(PI)-6794.8( )]TJ ET 491.25 -334.66 m 478.05 -334.66 l S BT 10 0 0 10 478.05 665.34 Tm -0.013 Tc 0 Tw (FU)Tj -38.055 -1.299 TD -0.0244 Tc [(A)-8057.4(-.58)-5874.4(-.32)-4674.4(-.45)]TJ /F1 1 Tf 29.175 0 TD -0.0237 Tc (1.48)Tj /TT3 1 Tf 8.325 0 TD -0.0261 Tc (-0.58)Tj -37.5 -1.299 TD -0.0212 Tc [(B)-8354.2(.50)-6171.2(.99)-4971.2(.74)-5046.2(0.17)]TJ /F1 1 Tf 37.5 0 TD -0.026 Tc (-1.32)Tj /TT3 1 Tf -37.5 -1.302 TD -0.0201 Tc [(C)-8297.9(.58)-6170.1(.58)-4970.1(.58)]TJ /F1 1 Tf 28.875 0 TD -0.026 Tc (-1.15)Tj /TT3 1 Tf 8.625 0 TD -0.006 Tc -0.0025 Tw ( ---)Tj -37.5 -1.299 TD -0.0241 Tc 0.0413 Tw [(4)-8167.9(-.57)-5649.1(1.16)-30.1( -)-21.1(-)-21.1(-)-27.1( -)-21.1(-)-21.1(-)-6465.1( )25.7( )25.7( )25.7(-)-20.6(-)-20.6(-)]TJ T* [(5)-8167.9(-.58)-5649.1(1.15)-30.1( -)-21.1(-)-21.1(-)-27.1( -)-21.1(-)-21.1(-)-6465.1( )25.7( )25.7( )25.7(-)-20.6(-)-20.6(-)]TJ 0 -1.302 TD 0 Tw [(6)-8167.8(-.29)-5649(1.11)-4974(.41)-4749(-0.82)]TJ 0 -1.299 TD -0.0226 Tc 0.0398 Tw [(7)-8466.4(.92)-5872.6(-.63)-28.6( -)-19.6(-)-19.6(-)-25.6( -)-19.6(-)-19.6(-)-6463.6( )25.7( )25.7( )25.7(-)-19.1(-)-19.1(-)]TJ T* -0.0243 Tc 0.0158 Tw [(8)-8168.1(-.13)-5874.3(-.92)-4674.3(-.53)-5049.3(1.06)-6474.3( -)-20.8(-)-20.8(-)]TJ 0 -1.302 TD -0.0261 Tc 0.0176 Tw [(9)-8469.9(.)-6(5)-6(8)-6176.1(.)-6(5)-6(8)-4976.1(.)-6(5)-6(8)-4751.1(-1.15)-6476.1( -)-22.6(-)-22.6(-)]TJ 0 -1.299 TD [(1)36.2(0)-7976.1(.)-6(5)-6(8)-6176.1(.)-6(5)-6(8)-4976.1(.)-6(5)-6(8)-4751.1(-1.15)-6476.1( -)-22.6(-)-22.6(-)]TJ T* -0.0241 Tc 0.0413 Tw [(1)38.2(1)-7674.1(-.80)-5649.1(1.21)-30.1( -)-21.1(-)-21.1(-)-27.1( -)-21.1(-)-21.1(-)-6465.1( )25.7( )25.7( )25.7(-)-20.6(-)-20.6(-)]TJ 0 -1.302 TD 0.0208 Tc 0 Tw [(1)83.1(2)14.8( 0)17.8( 0)14.8( 0)14.8( 0)-6408.2( )29.3( )29.3( )29.3(-)24.3(-)24.3(-)]TJ /F19 1 Tf 10 0 2.1256 10 97.5 476.34 Tm -0.0048 Tc -0.0013 Tw (Note: B1 = Baseline 1/ First Assessment; B2 = Baseline 2/Beginning of Exercise Program \(5)Tj 0.2761 -1.299 TD -0.005 Tc -0.0021 Tw [(w)12(eeks post-Baseline 1\);)46( B = A)37(v)24(e)5(r)4(age of the tw)7(o baseline scores;)46( PI = P)46(ost-inter)-35(v)24(ention/End of)]TJ 0.2761 -1.299 TD -0.0048 Tc -0.058 Tw (5-Week Aerobic Exercise Program; FU = Follow-up/One month following the post-intervention)Tj 0.2767 -1.302 TD -0.0051 Tc -0.0378 Tw [(assessment.)54.9( Dashes indicate that data w)6.9(ere not obtained or repor)-47.1(ted.)54.9( P)45.9(ost-inter)-35.1(v)26.9(ention and)]TJ 0.2761 -1.299 TD -0.0045 Tc -0.0193 Tw [(follow-up scores that differed significantly from the average baseline score are in bold print, p )]TJ ET 0.54 w 509.25 423.37 m 503.79 423.37 l S BT /F25 1 Tf 10 0 2.1 10 503.79 424.35 Tm 0 Tc 0 Tw (<)Tj /F19 1 Tf 10 0 2.1256 10 97.5 411.36 Tm -0.006 Tc (.05.)Tj ET 0.99 w 1000 M /GS1 gs 55.495 731.505 490.01 -232.01 re S endstream endobj 245 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F19 67 0 R /F25 236 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 247 0 obj << /Length 8368 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (57)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0029 Tc 0.0307 Tw [(found, clinically the participant)54.1(s level of total anxiety rose)]TJ 0 -1.398 TD -0.0027 Tc -0.0309 Tw (only to the average range, the range typical for a child of her)Tj 0 -1.401 TD -0.0038 Tc -0.0623 Tw (age. Exercise was not associated with any increase in anxiety)Tj T* -0.0033 Tc -0.0525 Tw (to subclinical or clinical levels.)Tj 1.8 -1.998 TD -0.0041 Tc -0.0625 Tw (The results found with the MASC were somewhat unex-)Tj -1.8 -1.401 TD -0.0017 Tc 0.125 Tw (pected, given past research that has documented the rela-)Tj T* -0.0034 Tc 0.0614 Tw (tionship between aerobic exercise and anxiety reduction in)Tj 0 -1.398 TD -0.0211 Tc -0.0625 Tw (children \(Brown et al., 1992; Hilyer et al., 1982; Norris, Carroll,)Tj 0 -1.401 TD -0.0091 Tc -0.0622 Tw (& Cochrane, 1992\). Low initial levels of anxiety may account)Tj T* -0.0032 Tc 0.05 Tw (for the low number of statistically significant reductions in)Tj 0 -1.398 TD -0.0022 Tc 0.125 Tw [(total anxiety symptomatology in this sample. )18.8(W)89.7(alters and)]TJ 0 -1.401 TD -0.0038 Tc 0.0229 Tw (Martin \(2000\), Crews, Lochbaum, and Landers \(2004\), and)Tj T* -0.0393 Tw (Hinkle, Tuckman, and Sampson \(1993\) attributed weak sup-)Tj 0 -1.398 TD -0.0033 Tc 0.05 Tw (port for the benefits of exercise on psychological function-)Tj 0 -1.401 TD -0.0029 Tc 0.0605 Tw (ing to low initial rates of psychopathology in their studies.)Tj T* -0.0032 Tc 0.0382 Tw (The current study may have shared the same weakness.)Tj 1.8 -1.998 TD -0.001 Tc 0.125 Tw (The majority of participants did not show significant)Tj -1.8 -1.401 TD -0.0034 Tc 0.029 Tw (reductions in depressive symptomatology between baseline)Tj T* -0.0043 Tc -0.0621 Tw (and post-intervention. The levels of symptomatology for two)Tj 0 -1.398 TD 0.0216 Tc 0.125 Tw (participants appeared to increase significantly between)Tj 0 -1.401 TD -0.0063 Tc -0.0624 Tw [(baseline and post-intervention. However)35.7(, clinically)56.7(, both par)17.7(-)]TJ T* -0.0038 Tc 0.0325 Tw (ticipants scores on the CDI remained within the average)Tj 0 -1.398 TD -0.0033 Tc 0.0044 Tw [(range across the phases of the study)59.7(. Exercise was not asso-)]TJ 0 -1.401 TD -0.0032 Tc -0.0383 Tw (ciated with any increase in depression to subclinical or clini-)Tj T* -0.0038 Tc -0.06 Tw (cal levels.)Tj 1.8 -1.998 TD 0.0744 Tw (The results found with the CDI were somewhat unex-)Tj -1.8 -1.401 TD -0.0032 Tc 0.0145 Tw (pected, given the solid body of past research that had docu-)Tj T* 0.0308 Tc 0.125 Tw (mented the relationship between aerobic exercise and)Tj 0 -1.398 TD -0.009 Tc -0.0625 Tw (depression in children \(Brown et al., 1992; Crews et al., 2004;)Tj 0 -1.401 TD -0.0038 Tc 0.0296 Tw [(MacMahon & Gross, 1987\). )50.3(As was the case in the )17.3(W)94(alters)]TJ T* -0.018 Tc -0.0623 Tw (and Martin \(2000\), Crews et al. \(2004\), and Hinkle et al. \(1993\))Tj 0 -1.398 TD -0.0032 Tc 0.0745 Tw (studies, perhaps a sample with higher initial levels of psy-)Tj 0 -1.401 TD -0.0041 Tc -0.0625 Tw (chopathology may have shown greater benefit from the aero-)Tj T* -0.0092 Tc (bic exercise program.)Tj /F1 1 Tf 11 0 0 11 66 210 Tm -0.0052 Tc 0.1 Tw (Exploratory Analyses)Tj /TT2 1 Tf 10 0 0 10 84 186.66 Tm -0.0035 Tc 0.1087 Tw (The results were indicative of the maintenance of the)Tj -1.8 -1.401 TD -0.0099 Tc -0.0621 Tw (beneficial effects of aerobic exercise on trauma-related symp-)Tj T* -0.0035 Tc -0.0338 Tw [(tomatology)59.5(. On the CPSS, the levels of PTSD symptomatol-)]TJ 0 -1.398 TD -0.0031 Tc 0.0665 Tw (ogy were maintained, or had even decreased, for at least 4)Tj 0 -1.401 TD -0.0034 Tc -0.0137 Tw (weeks post-intervention for all three girls, despite the cessa-)Tj T* -0.0159 Tc -0.0623 Tw (tion of the exercise program. On the TSCC, the levels of symp-)Tj 0 -1.398 TD 0.0182 Tc 0.125 Tw [(tomatology for all three girls decreased to the point of)]TJ 0 -1.401 TD -0.0022 Tc (statistical significance at the follow-up assessment. These)Tj 25.5 63.399 TD -0.0029 Tc (results contrast with those of Newman and Motta \(2007\),)Tj 0 -1.398 TD -0.0036 Tc -0.0489 Tw (who found no maintenance of the positive effects of exercise)Tj 0 -1.401 TD 0.0767 Tw (on psychological functioning 1 month following participa-)Tj T* -0.0059 Tc -0.0625 Tw (tion in an aerobic exercise program. The cause of the discrep-)Tj 0 -1.398 TD 0.0555 Tc 0.1251 Tw [(ancy between the studies is unclear)49.5(. However)34.5(, this)]TJ 0 -1.401 TD -0.0034 Tc 0.0569 Tw [(discrepancy is consistent with the mixed findings of previ-)]TJ T* -0.0032 Tc 0.0033 Tw [(ous studies. Clearly)59.8(, further research is warranted.)]TJ 1.8 -1.998 TD -0.0174 Tc -0.0621 Tw [(Results with the MASC and CDI were mixed. )51.7(Again, such)]TJ -1.8 -1.401 TD 0.0065 Tc 0.125 Tw (inconsistency is fairly consistent with previous research.)Tj T* -0.0032 Tc 0.0251 Tw [(S)22(titch)53.8(s)-0.1( \(1999\) review of the literature indicated that only a)]TJ 0 -1.398 TD -0.0025 Tc 0.125 Tw (small number of studies investigating the relationship be-)Tj 0 -1.401 TD -0.0035 Tc -0.0564 Tw (tween exercise and anxiety or depression included follow-up)Tj T* 0.0001 Tc 0.1253 Tw [(assessments of functioning. However)36.1(, the majority of the)]TJ 0 -1.398 TD 0.0033 Tc 0.125 Tw (studies indicated that significant reductions in anxiety or)Tj 0 -1.401 TD -0.0039 Tc 0.0688 Tw (depression were maintained between 4 and 15 months. On)Tj T* -0.0037 Tc -0.0035 Tw (the other hand, Brown et al. \(1992\) and Newman and Motta)Tj 0 -1.398 TD -0.0035 Tc 0.0844 Tw (\(2007\) found no maintenance of reductions in anxiety and)Tj 0 -1.401 TD -0.0037 Tc 0.04 Tw (depression at a 1-month follow-up assessment of participa-)Tj T* -0.0089 Tc -0.0623 Tw (tion in an aerobic exercise program. In addition, McEntee and)Tj 0 -1.398 TD -0.0038 Tc 0.1108 Tw [(Halgin \(1999\) found no maintenance of significant reduc-)]TJ 0 -1.401 TD -0.0026 Tc -0.0339 Tw [(tions in anxiety)60.4(. Clearly)63.4(, further research is needed to clarify)]TJ T* -0.0039 Tc 0.12 Tw (previous findings.)Tj 1.8 -1.998 TD -0.0034 Tc -0.0106 Tw (It should be noted that none of the participants reported)Tj -1.8 -1.401 TD -0.0193 Tw (continued participation in a structured, regular aerobic exer-)Tj T* -0.0074 Tc -0.0623 Tw (cise program at the follow-up assessment. The lack of partici-)Tj 0 -1.398 TD -0.0032 Tc -0.05 Tw (pation may reflect the individuals choices to avoid exercise.)Tj 0 -1.401 TD -0.0046 Tc -0.0622 Tw [(However)37.4(, it may also reflect limited opportunities for partici-)]TJ T* -0.0033 Tc -0.05 Tw [(pation in exercise programs within the residential facility)59.7(.)]TJ /F1 1 Tf 11 0 0 11 321 300 Tm -0.0036 Tc 0 Tw (Implications)Tj /TT2 1 Tf 10 0 0 10 339 276.66 Tm 0.09 Tw (Current findings suggest that moderate-intensity aero-)Tj -1.8 -1.401 TD -0.0034 Tc 0.0428 Tw (bic exercise is a valid adjunct to more traditional treatment)Tj T* -0.0016 Tc 0.125 Tw (methods for PTSD, including psychotherapeutic interven-)Tj 0 -1.398 TD -0.0035 Tc 0.0992 Tw [(tions and psychotropic medication. )50.5(Aerobic exercise treat-)]TJ 0 -1.401 TD 0.0105 Tc 0.125 Tw (ment for PTSD may be appropriate for individuals who)Tj T* -0.0022 Tc (demonstrate difficulty with the verbal processing, expres-)Tj 0 -1.398 TD -0.0037 Tc -0.04 Tw (sive language, and receptive language skills needed for talk)Tj 0 -1.401 TD 0.0018 Tc 0.125 Tw (therapies, such as cognitive-behavior therapy \(Morris &)Tj T* -0.0216 Tc -0.0623 Tw (Kratochwill, 1983; Salmon & Bryant, 2002\). In addition, it may)Tj 0 -1.398 TD -0.0037 Tc 0.0793 Tw (be more appropriate than exposure techniques for children)Tj 0 -1.401 TD -0.0034 Tc 0.034 Tw (with concentration difficulties, self-control difficulties, his-)Tj T* -0.0033 Tc 0.0941 Tw (tories of sexual abuse, comorbid psychosis, attention-defi-)Tj 0 -1.398 TD 0.05 Tw (cit/hyperactivity disorder \(ADHD\), conduct disorder \(CD\),)Tj 0 -1.401 TD -0.001 Tc 0.1251 Tw [(substance abuse, and cognitive impairment \(Saigh, )29.1(Y)100.2(asik,)]TJ T* -0.0151 Tc -0.0621 Tw [(Oberfield, & Inamdar)41.9(, 1999; Salmon & Bryant, 2002\).)]TJ ET endstream endobj 248 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 251 0 obj << /Length 9022 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.1063 Tw [(58 )]TJ /TT3 1 Tf 2.2463 0 TD -0.0054 Tc 0.107 Tw (Diaz and Motta Aerobic Exercise and Posttraumatic Stress)Tj /F1 1 Tf 11 0 0 11 54 723.99 Tm -0.0042 Tc 0.0472 Tw (Strengths and Limitations of the Current)Tj 0 -1.0909 TD -0.0056 Tc 0 Tw [(In)35.3(vestigation)]TJ /TT2 1 Tf 10 0 0 10 72 688.65 Tm -0.0026 Tc -0.0517 Tw [(In terms of strengths, the study may be replicated easily)60.4(.)]TJ -1.8 -1.401 TD -0.0032 Tc 0.0564 Tw [(The intervention involved simple physical activity)59.8(, and the)]TJ 0 -1.398 TD -0.0029 Tc 0.0571 Tw [(activity was clearly defined. )51(Also, there was no attrition in)]TJ 0 -1.401 TD -0.0005 Tc 0.125 Tw (the current study between the baseline and post-interven-)Tj T* 0.002 Tc [(tion phases. )17(T)72.8(wo reasons may account for this. First, the)]TJ 0 -1.398 TD -0.0056 Tc -0.0625 Tw (sample was drawn from a captive population, meaning that)Tj 0 -1.401 TD -0.0034 Tc 0.1169 Tw [(all participants resided at the treatment center)53.6(. On several)]TJ T* -0.0005 Tw (occasions, we noted that the girls were often eager to attend)Tj 0 -1.398 TD -0.0035 Tc -0.0205 Tw (the exercise sessions in order to escape their residences. It)Tj 0 -1.401 TD -0.0033 Tc 0.0778 Tw [(is possible that the enjoyment of the escape contributed to)]TJ T* -0.0034 Tc -0.0358 Tw (the beneficial effects of the exercise program.)Tj 1.8 -1.998 TD 0.0627 Tw (The second factor contributing to the high rate of par-)Tj -1.8 -1.401 TD -0.0031 Tc 0.0443 Tw [(ticipation may have been the reward system. )14.8(W)97.7(e)0.9( addressed)]TJ T* -0.0034 Tc -0.0367 Tw (the issue of high attrition rates observed in previous exercise)Tj 0 -1.398 TD -0.0032 Tc 0.0505 Tw (studies by promising the girls a pizza dinner at the conclu-)Tj 0 -1.401 TD -0.0028 Tc 0.065 Tw [(sion of the study)60.2(.)]TJ 1.8 -2.001 TD -0.0075 Tc -0.0622 Tw (Several limitations of the current investigation are noted.)Tj -1.8 -1.398 TD -0.0026 Tc 0.0758 Tw (First, the study employed a small )Tj /TT7 1 Tf 13.896 0 TD 0 Tc 0 Tw (N)Tj /TT2 1 Tf 0.66 0 TD -0.0036 Tc 0.0762 Tw [( design. Such a design)]TJ -14.556 -1.401 TD -0.0032 Tc -0.0183 Tw [(limits external validity)59.8(. It should be noted, however)38.8(, that the)]TJ T* -0.0035 Tc -0.0177 Tw [(current study)53.5(s sample size was lar)14.5(ger than the two previous)]TJ 0 -1.398 TD -0.0029 Tc 0.0618 Tw (studies that found beneficial effects of physical activity on)Tj 0 -1.401 TD -0.0035 Tc 0.0626 Tw [(PTSD symptomatology)59.5(. Manger)-36.5()53.5(s)-0.3( \(2000\) study involved 9)]TJ T* -0.0073 Tc -0.0621 Tw [(participants, and Newman and Motta)52.7(s \(2007\) study involved)]TJ 0 -1.398 TD -0.0037 Tc -0.035 Tw (11 participants.)Tj 1.8 -2.001 TD 0.0909 Tw (Additional limitations of our investigation include the)Tj -1.8 -1.401 TD -0.0105 Tc -0.0625 Tw (lack of a control group, limited information regarding specific)Tj 0 -1.398 TD -0.0037 Tc 0.0375 Tw (trauma histories and treatment programs, limited follow-up)Tj 0 -1.401 TD -0.0034 Tc -0.0269 Tw [(assessment data, lack of a blind researcher)35.6(, and lack of blind)]TJ T* 0.0029 Tc 0 Tw (participants.)Tj /F1 1 Tf 11 0 0 11 54 246 Tm -0.0058 Tc 0.0659 Tw (Summary and Recommendations)Tj /TT2 1 Tf 10 0 0 10 72 222.66 Tm -0.0032 Tc 0.0366 Tw (The results of the current study are promising in terms)Tj -1.8 -1.401 TD -0.0101 Tc -0.0625 Tw (of their support for the beneficial effects of exercise on PTSD,)Tj T* -0.0033 Tc -0.0051 Tw [(anxiety)62.7(, and depression symptoms. )14.6(The beneficial ef)17.7(fects of)]TJ 0 -1.398 TD -0.0031 Tc 0.085 Tw (aerobic activity on PTSD symptomatology were expected,)Tj 0 -1.401 TD -0.0037 Tc 0.065 Tw (given previous research findings.)Tj 1.8 -2.001 TD -0.0033 Tc -0.0622 Tw (Further research is recommended to clarify current find-)Tj -1.8 -1.398 TD -0.003 Tc -0.0419 Tw [(ings, remedy the current study)51(s flaws, and expand scientific)]TJ 0 -1.401 TD -0.0039 Tc 0.065 Tw (knowledge regarding the relationships among PTSD, anxi-)Tj T* -0.0029 Tc 0.1109 Tw [(ety)60.1(, depression, and physical exercise. Investigators in fu-)]TJ 0 -1.398 TD 0.0093 Tc 0.125 Tw (ture studies may wish to compare the effects of aerobic)Tj 0 -1.401 TD -0.0038 Tc 0.0514 Tw (exercise treatment to other PTSD treatment methods, com-)Tj 25.5 64.599 TD -0.0009 Tc 0.125 Tw (pare the effectiveness of aerobic exercise to that of other)Tj 0 -1.398 TD -0.0031 Tc -0.0294 Tw (physical activities \(such as anaerobic exercise\), and alter the)Tj 0 -1.401 TD 0.0531 Tw (duration and frequency of exercise treatment sessions. It is)Tj T* -0.0038 Tc 0.0792 Tw (recommended that for future investigations information be)Tj 0 -1.398 TD -0.0037 Tc -0.0216 Tw (obtained regarding preexisting treatment programs for clini-)Tj 0 -1.401 TD -0.0036 Tc -0.062 Tw (cal samples, including therapeutic and psychopharmacologi-)Tj T* 0.0517 Tw (cal services. Comparisons of the use of aerobic exercise as)Tj 0 -1.398 TD -0.0033 Tc -0.015 Tw (the primary or adjunct treatment should be explored.)Tj 1.8 -2.001 TD 0.075 Tw (New directions are encouraged. No researcher has yet)Tj -1.8 -1.401 TD -0.0152 Tc -0.0622 Tw (examined the relationship between aerobic exercise and PTSD)Tj 0 -1.398 TD 0.0241 Tc 0.125 Tw (symptomatology with male, preschool-age, elementary)Tj 0 -1.401 TD -0.0037 Tc 0.0112 Tw (school-age, and middle school-age children.)Tj 1.8 -2.001 TD -0.0034 Tc -0.0258 Tw [(Finally)62.6(,)0.1( it is recommended that future research examine)]TJ -1.8 -1.398 TD -0.0037 Tc 0.0382 Tw [(the mechanism\(s\) of change associated with the benefits of)]TJ 0 -1.401 TD -0.0029 Tc -0.0406 Tw [(aerobic exercise. Currently)63.1(, there are no widely accepted ex-)]TJ T* -0.0031 Tc 0.0986 Tw (planations for the psychological benefits of physical exer-)Tj 0 -1.398 TD -0.0012 Tc 0 Tw (cise.)Tj /F1 1 Tf 11 0 0 11 388.89 453.99 Tm 0.021 Tc (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 309 436.65 Tm -0.0128 Tc -0.0617 Tw [(Asarnow)62.2(, J.K., & Carlson, G)116.2(.A. \(1985\). 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Susy Sanders, PhD, CTS, CAS, a)]TJ 0 -1.2233 TD -0.0047 Tc -0.0433 Tw (licensed psychologist, is President of the Board of Directors of the)Tj T* -0.0054 Tc -0.0145 Tw [(Association of T)47.9(raumatic S)27.9(t)4.9(r)34.6(ess Specialists \(A)34.6(TSS\). Dr)104.6(. Sanders is)]TJ 0 -1.22 TD -0.0146 Tc -0.0623 Tw [(Chair)102.1(, S)22.1(tate of Maine Psychological )12.5(Association Disaster Response,)]TJ 0 -1.2233 TD 0.0342 Tc 0.125 Tw [(a S)27.5(tate of Maine Disaster Behavioral Health T)50.9(rainer)107.5(, and)]TJ T* -0.0053 Tc 0.0564 Tw [(psychologist and Cer)-8.6(tified T)51.4(rauma Specialist at Morning Bridge)]TJ 0 -1.22 TD -0.0048 Tc 0.1023 Tw (Center in Phillips, ME. Correspondence concerning this article)Tj 0 -1.2233 TD -0.004 Tc 0.0702 Tw (should be sent to: Susy Sanders, Ph.D., CTS, CAS, 18 Main St.,)Tj T* -0.0046 Tc -0.0024 Tw (Box 251, Phillips, ME 04966. E-mail: susynow@hotmail.com.)Tj /F1 1 Tf 14 0 0 14 100.26 629.34 Tm -0.0052 Tc 0.1376 Tw [(Cer)-26.6(tification and the Pledg)-18(e of Excellence in )95.6(T)80.8(raumatic Stress)]TJ 11.8136 -1.1421 TD 0.0169 Tc 0 Tw (Interventions)Tj /TT2 1 Tf 10 0 0 10 84 328.65 Tm -0.0017 Tc 0.125 Tw (The need for psychosocial support following critical)Tj -1.8 -1.401 TD 0.042 Tc (incidents has been well documented \(Caplan, 1964;)Tj 0 -1.398 TD -0.0034 Tc 0.0302 Tw [(Hartsough & Myers, 1985; Everly)59.6(, 1995; )17.8(V)115.8(ernber)14.6(g, 2002\).)]TJ 0 -1.401 TD -0.0035 Tc 0.0536 Tw (During times of need, many individuals and organizations)Tj T* 0.0967 Tw [(respond, wishing to be of service. )50.4(A)58.6( number of or)17.4(ganiza-)]TJ 0 -1.398 TD -0.0034 Tc -0.058 Tw (tions have risen to the task, seeking to provide mental health)Tj 0 -1.401 TD -0.0032 Tc -0.047 Tw (support and crisis services. 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It is difficult for the public to be certain whether)Tj 0 -1.398 TD 0.0532 Tw (the support they are receiving is going to be helpful or po-)Tj 0 -1.401 TD -0.0034 Tc 0.0528 Tw (tentially harmful. One method available, drawn upon well-)Tj T* -0.0044 Tc -0.0622 Tw (established practices in other fields, is that of certifying crisis)Tj 0 -1.398 TD -0.0038 Tc 0.1017 Tw (interventionists and trauma counselors.)Tj 1.8 -2.001 TD -0.0138 Tc -0.0625 Tw (Mental health professionals in the field of traumatic stress)Tj -1.8 -1.401 TD -0.0036 Tc -0.0138 Tw (have long promoted the highest standards of practice. These)Tj 0 -1.398 TD -0.0033 Tc 0.0031 Tw (standards are not static. Instead, as research illuminates fur-)Tj 0 -1.401 TD -0.0032 Tc 0.042 Tw (ther the dynamics of the stress response, as well as provid-)Tj T* -0.004 Tc -0.0625 Tw (ing insights into how traumatized people respond to different)Tj 0 -1.398 TD -0.0034 Tc 0.0581 Tw (interventions, the standards of practice evolve as well. De-)Tj 0 -1.401 TD -0.0037 Tc 0.1065 Tw (pending on the timing and circumstances, traumatic stress)Tj T* 0 Tc 0.125 Tw (interventions represent either specialized support services)Tj 0 -1.398 TD -0.0066 Tc -0.0625 Tw (or treatment paradigms that require practitioners to keep pace)Tj ET endstream endobj 268 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 270 0 obj << /Length 8781 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.0813 Tw [(62 )]TJ /TT3 1 Tf 2.1712 0 TD -0.0053 Tc (Sanders Trauma Certification and the Pledge of Excellence)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0037 Tc 0.0375 Tw (with evolving practice parameters. Thoughtful providers of)Tj 0 -1.398 TD -0.0035 Tc 0.075 Tw (trauma services recognize that often those practices, based)Tj 0 -1.401 TD -0.0039 Tc -0.0144 Tw (in what might be termed common sense, are not necessar-)Tj T* -0.0028 Tc 0.0607 Tw (ily therapeutic. Poorly thought out and carelessly executed)Tj 0 -1.398 TD -0.0031 Tc -0.0118 Tw [(services may)62.9(, in some case, cause harm.)]TJ 1.8 -2.001 TD -0.0035 Tc 0.0468 Tw (There are two main categories of trained provider per-)Tj -1.8 -1.401 TD -0.0093 Tc -0.0622 Tw (sonnel in the traumatic stress field: those with clinically based)Tj 0 -1.398 TD -0.0035 Tc 0.125 Tw (academic degrees and paraprofessional support personnel.)Tj 0 -1.401 TD -0.0032 Tc -0.0356 Tw [(The first category is made up of mental health professionals.)]TJ T* -0.0034 Tc -0.044 Tw [(Unfortunately)62.6(, accurate, hands-on intervention strategies are)]TJ 0 -1.398 TD 0.0157 Tw (not normally included in the more generalized training pro-)Tj 0 -1.401 TD -0.0017 Tw (vided through university curricula, whether for undergradu-)Tj T* -0.0029 Tc 0.0256 Tw (ate or graduate programs of study in psychology and social)Tj 0 -1.398 TD -0.0038 Tc 0.0834 Tw (work. Some specialized traumatic stress training programs)Tj 0 -1.401 TD -0.0031 Tc 0.0513 Tw [(have recently been developed in university settings. How-)]TJ T* -0.0037 Tc 0.0496 Tw [(ever)35.3(, these programs do not serve the lar)17.3(ge number of pro-)]TJ 0 -1.398 TD -0.0034 Tc 0.0335 Tw (fessionals currently engaged in trauma work. Most training)Tj 0 -1.401 TD -0.0036 Tc 0.125 Tw (programs that focus on trauma intervention and treatment)Tj T* -0.0037 Tc 0.0609 Tw (are specialized postgraduate internships and fellowships or)Tj 0 -1.398 TD -0.0038 Tc -0.0083 Tw (continuing education seminars and workshops, either stand-)Tj 0 -1.401 TD -0.0064 Tc -0.0625 Tw (alone or connected with major conferences. Given the impor-)Tj T* -0.0036 Tc 0.0037 Tw (tance of using particular standards and paradigms in trauma)Tj 0 -1.398 TD -0.0033 Tc -0.0131 Tw (work, coupled with the fact that there is a significant lack of)Tj 0 -1.401 TD -0.0099 Tc -0.062 Tw (specialized university programming, questions naturally arise)Tj T* -0.0038 Tc 0.0792 Tw (concerning the appropriate assessment of clinician compe-)Tj 0 -1.398 TD 0.0081 Tc 0 Tw (tence.)Tj 1.8 -2.001 TD -0.0033 Tc -0.0375 Tw (The second category of providers in the traumatic stress)Tj -1.8 -1.401 TD -0.0034 Tc 0.0238 Tw (field are the paraprofessionals including, but not limited to,)Tj 0 -1.398 TD -0.0077 Tc -0.0625 Tw (police officers, fire fighters, paramedics, nurses, communica-)Tj 0 -1.401 TD -0.0034 Tc 0.1235 Tw [(tion specialists, and military personnel. )50.5(As Gerald Caplan)]TJ T* -0.0069 Tc -0.0625 Tw (\(1964\) pointed out more than 40 years ago, excellent help can)Tj 0 -1.398 TD 0.0041 Tc 0.125 Tw (be provided by people who do not hold professional de-)Tj 0 -1.401 TD -0.0031 Tc 0.0454 Tw (grees. That is not to say that peer support personnel do not)Tj T* -0.003 Tc -0.0006 Tw (need training or appropriate certifications. They do, and my)Tj 0 -1.398 TD -0.004 Tc 0.0334 Tw [(own or)14(ganization, the )52.8(Association of )13.8(T)36.8(raumatic S)17(tress Spe-)]TJ 0 -1.401 TD -0.0034 Tc 0.0856 Tw (cialists, as well as other accrediting bodies, has developed)Tj T* -0.0037 Tc 0.0817 Tw (accrediting procedures for paraprofessionals.)Tj 1.8 -1.998 TD 0.1179 Tw [(There are important questions, however)35.3(, that must be)]TJ -1.8 -1.401 TD 0.0767 Tw (answered regarding the methods that emergency managers)Tj T* -0.0036 Tc 0.05 Tw (and even consumers might employ to ascertain the compe-)Tj 0 -1.398 TD -0.0018 Tc 0.125 Tw (tence of professionals and paraprofessionals who respond)Tj 0 -1.401 TD -0.0083 Tc -0.0625 Tw [(to traumatic events in their communities. )51.7(Assessment of com-)]TJ T* -0.003 Tc 0.1237 Tw (petency is particularly important for those engaged in the)Tj 0 -1.398 TD -0.0037 Tc 0.0714 Tw (work of crisis intervention as paraprofessionals and whose)Tj 0 -1.401 TD -0.0032 Tc 0.0275 Tw (work does not require post-secondary education in the psy-)Tj T* -0.0036 Tc 0.0138 Tw (chosocial fields. The need to assure provider competence is)Tj 25.5 64.8 TD -0.0005 Tc 0.125 Tw (particularly essential as we recognize the vulnerability of)Tj 0 -1.398 TD -0.0029 Tc -0.0065 Tw (those in the midst of the disaster experience. Simply put, by)Tj 0 -1.401 TD -0.0037 Tc 0.0733 Tw (what standard do we judge the competence of these work-)Tj T* -0.0034 Tc 0.0584 Tw [(ers? )17.7(W)55.4(ithout a doubt, accurate standards must be engaged)]TJ 0 -1.398 TD -0.0174 Tw [(and upheld rigorously)62.6(, and the public must be assured of the)]TJ 0 -1.401 TD -0.0033 Tc -0.0155 Tw (proficiency of those who are serving them in their most vul-)Tj T* -0.0037 Tc 0.0344 Tw (nerable of moments. Possession of one or more specialized)Tj 0 -1.398 TD -0.0125 Tc -0.0621 Tw (certifications indicating such proficiency is one viable method)Tj 0 -1.401 TD -0.0036 Tc 0.048 Tw (of communicating competency and standards. Certification)Tj T* -0.0037 Tc 0.0975 Tw (for both mental health professionals and paraprofessionals)Tj 0 -1.398 TD -0.0033 Tc 0.0095 Tw (can provide a pledge of excellence that is essential for us to)Tj 0 -1.401 TD 0.0084 Tw (subscribe to in all that we do.)Tj 1.8 -2.001 TD -0.0037 Tc 0.0536 Tw [(As a result, a number of trauma-focused organizations)]TJ -1.8 -1.398 TD -0.0034 Tc -0.0394 Tw (have recognized the viability of this method of communicat-)Tj 0 -1.401 TD -0.0037 Tc 0.0771 Tw (ing competency and have developed and promoted trauma)Tj T* -0.0173 Tc -0.0625 Tw (certifications. The key organizations offering specialized train-)Tj 0 -1.398 TD -0.0034 Tc 0.0036 Tw (ing and certification in traumatic stress management are the)Tj 0 -1.401 TD -0.0037 Tc 0.01 Tw (Association of Traumatic Stress Specialists, National Orga-)Tj T* -0.0036 Tc -0.0316 Tw [(nization of )14.5(V)64.6(ictim )53.5(Assistance, International Critical Incident)]TJ 0 -1.398 TD -0.0159 Tc -0.0621 Tw [(S)21.3(tress Foundation, and )47.5(American )50.5(Academy of Experts in )20.5(T)39.9(rau-)]TJ 0 -1.401 TD -0.0035 Tc -0.0068 Tw (matic Stress. In light of the numerous difficulties associated)Tj T* -0.0408 Tw (with emergency mental health response following the Hurri-)Tj 0 -1.398 TD -0.0034 Tc -0.0368 Tw [(cane Katrina disaster)35.6(, several state governments, as well, are)]TJ 0 -1.401 TD -0.0037 Tc -0.0625 Tw (implementing disaster mental health certification.)Tj 1.8 -2.001 TD -0.0033 Tc -0.0534 Tw (This article will review and evaluate the range of certifi-)Tj -1.8 -1.398 TD -0.0032 Tc -0.0383 Tw [(cations of)17.8(fered in the field of traumatic stress services today)59.8(.)]TJ 0 -1.401 TD -0.0125 Tc -0.0625 Tw (It will also make recommendations for further development of)Tj T* -0.0035 Tc 0.0472 Tw (the certification method of promoting excellence. First, the)Tj 0 -1.398 TD 0.0547 Tc 0.125 Tw (definition of certification will be explored through)Tj 0 -1.401 TD -0.0033 Tc -0.0407 Tw (deconstructing a typical certification process into its compo-)Tj T* -0.0018 Tc 0.125 Tw (nents. Each component will be examined to elucidate the)Tj 0 -1.398 TD -0.0038 Tc -0.058 Tw [(mechanisms behind certification. )17.5(Thereafter)35.2(, the process and)]TJ 0 -1.401 TD -0.0107 Tc -0.0621 Tw (requirements of various categories of trauma certification will)Tj T* -0.0033 Tc -0.025 Tw [(be scrutinized. Finally)59.7(, the article will conclude with recom-)]TJ 0 -1.398 TD -0.0037 Tc -0.0058 Tw (mendations for dynamic and comprehensive preparation for)Tj 0 -1.401 TD -0.0156 Tc -0.06 Tw (trauma work.)Tj /F1 1 Tf 11 0 0 11 309 188.01 Tm -0.0036 Tc 0.1409 Tw (Certification Deconstructed)Tj /TT2 1 Tf 10 0 0 10 327 164.64 Tm -0.0044 Tw (If certification is promoted as a method of assuring and)Tj -1.8 -1.398 TD 0.055 Tw (communicating competence, it is a given that the certifica-)Tj 0 -1.401 TD -0.0033 Tc -0.0372 Tw (tion necessarily must accomplish what it purports. Certifica-)Tj T* -0.0037 Tc 0.1069 Tw (tion must represent true competence and the upholding of)Tj 0 -1.398 TD -0.0034 Tc 0.1067 Tw [(accurate standards of practice. )50.6(A)58.8( careful review of what a)]TJ 0 -1.401 TD -0.0031 Tc -0.0415 Tw (certification is and the criteria that are required for that certi-)Tj T* -0.0033 Tc -0.0322 Tw (fication will help to clarify the manner in which competence)Tj ET endstream endobj 271 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 273 0 obj << /Length 8429 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (63)Tj /TT2 1 Tf 10 0 0 10 66 722.64 Tm -0.0034 Tc 0.0685 Tw [(and standards are represented. Further)35.6(, certifications in the)]TJ 0 -1.398 TD -0.0136 Tc -0.0621 Tw (field of traumatic stress often represent specialized paradigms,)Tj 0 -1.401 TD -0.0026 Tc -0.0205 Tw (yet these are not always clearly differentiated for the public.)Tj T* -0.0037 Tc -0.0169 Tw (This lack of differentiation poses a problem in communicat-)Tj 0 -1.398 TD -0.003 Tc 0.0477 Tw (ing clearly with the public. In other words, just what is the)Tj 0 -1.401 TD -0.0029 Tc -0.0306 Tw (area of expertise claimed by the holder of the certificate?)Tj 1.8 -2.001 TD -0.0035 Tc 0.0536 Tw (In the process of deconstructing certifications, we will)Tj -1.8 -1.398 TD -0.0046 Tc -0.0622 Tw (examine four areas: 1\) what a certification represents, in gen-)Tj 0 -1.401 TD -0.0031 Tc 0.0685 Tw (eral; 2\) a description of the criteria for certification; 3\) the)Tj T* -0.0034 Tc -0.0092 Tw (process by which standards for certification are determined;)Tj 0 -1.398 TD -0.0032 Tc 0.0272 Tw (and 4\) the method by which competency in these standards)Tj 0 -1.401 TD -0.01 Tc -0.0625 Tw (is determined. Following this deconstruction, the components)Tj T* -0.0034 Tc 0.008 Tw (of certification will be used as a template for examining the)Tj 0 -1.398 TD -0.0031 Tc -0.0078 Tw (various types of trauma certifications offered in the field to-)Tj 0 -1.401 TD 0.0086 Tc 0 Tw [(day)68.6(.)]TJ /TT7 1 Tf 11 0 0 11 66 487.35 Tm 0.0089 Tc 0.125 Tw (What is Certification)Tj /TT2 1 Tf 8.8309 0 TD 0 Tc 0 Tw (?)Tj 10 0 0 10 84 467.64 Tm 0.0021 Tc 0.125 Tw (Certification is defined broadly as an attestation that)Tj -1.8 -1.398 TD -0.0031 Tc 0.0168 Tw [(what is stated under the auspices of the certificate is true. It)]TJ 0 -1.401 TD -0.0033 Tc 0.0177 Tw (is a confirmation, guarantee, and assurance that the level of)Tj T* -0.0133 Tc -0.0622 Tw (professional practice claimed is accurate. In the case of trauma)Tj 0 -1.398 TD -0.0032 Tc -0.05 Tw (certifications, what is claimed to be true is that the certificate)Tj 0 -1.401 TD -0.0015 Tc 0.125 Tw (holders possess both training and experience that guaran-)Tj T* -0.003 Tc -0.0432 Tw (tees that the particular type of work they do with people who)Tj 0 -1.398 TD -0.0035 Tc 0.0069 Tw (have undergone trauma is based in best practices. Certifica-)Tj 0 -1.401 TD -0.024 Tw (tions represent confirmation of specialized expertise.)Tj 1.8 -2.001 TD -0.062 Tw (The basis of the confirmation and the nature of the claim)Tj -1.8 -1.398 TD -0.003 Tc -0.0295 Tw [(are often broad. Not all certification in any field of endeavor)]TJ 0 -1.401 TD -0.0036 Tc 0.0008 Tw (requires academic degrees, whether baccalaureate or gradu-)Tj T* -0.0032 Tc 0.098 Tw (ate. It would seem, then, that certifications that do not re-)Tj 0 -1.398 TD -0.0091 Tc -0.0622 Tw [(quire academic degrees must either make up for the perceived)]TJ 0 -1.401 TD -0.0134 Tc (deficit through rigorous requirements or employ some method)Tj T* -0.0035 Tc 0.0219 Tw (of measuring competence. For example, in many states one)Tj 0 -1.398 TD 0.0086 Tc 0.125 Tw (does not need to possess or earn an academic degree in)Tj 0 -1.401 TD -0.0035 Tc -0.0095 Tw [(order to earn a certification as an addiction counselor)50.5(. How-)]TJ T* -0.0053 Tc -0.0624 Tw [(ever)39.7(, there are still rigorous requirements that include college)]TJ 0 -1.398 TD -0.0034 Tc 0.0964 Tw (or specialized course work. Competency in accepted stan-)Tj 0 -1.401 TD -0.004 Tc 0.07 Tw (dards is measured through comprehensive examinations as)Tj T* -0.0059 Tc -0.0625 Tw (well as by logging a minimum number of hours of supervised)Tj 0 -1.398 TD -0.0035 Tc -0.0339 Tw (field experience. In some cases where an academic degree is)Tj 0 -1.401 TD -0.0031 Tc -0.0435 Tw (required, certification is synonymous with licensure. For ex-)Tj T* -0.0061 Tc -0.0622 Tw (ample, in order to provide mental health services, some states)Tj 0 -1.398 TD -0.0036 Tc 0.0084 Tw [(require individuals with a Master)-39.6()56.4(s)-0.2( degree in social work to)]TJ 0 -1.401 TD -0.0033 Tc 0.1183 Tw (become certified. The requirement, in such cases, is for a)Tj T* -0.0162 Tc -0.0625 Tw [(Certified Social )19.8(W)96.6(orker \(CSW\). In other states, licensure alone)]TJ 25.5 63.9 TD -0.0137 Tc (is required for the professional initials LCSW \(Licensed Clini-)Tj 0 -1.398 TD -0.0043 Tc [(cal Social )16.7(W)99.5(orker\) to be applicable. In all cases, regardless of)]TJ 0 -1.401 TD -0.0034 Tc 0.1064 Tw (the nomenclature of certification or licensure, the require-)Tj T* -0.0036 Tc 0.0833 Tw (ments include both academic and experiential verification.)Tj 0 -1.398 TD -0.0042 Tc 0.0475 Tw (Both of these certifications \(CSW and LCSW\) also require)Tj 0 -1.401 TD -0.0102 Tc -0.06 Tw (written examinations.)Tj 1.8 -2.001 TD -0.0033 Tc -0.0236 Tw [(In summary)59.7(, certification is a formal assurance that cer)17.7(-)]TJ -1.8 -1.398 TD -0.0035 Tc 0.1143 Tw (tain standards of professional practice have been attained.)Tj 0 -1.401 TD -0.0037 Tc -0.0491 Tw (Some certifications require academic degrees; others require)Tj T* -0.0038 Tc 0.0925 Tw (a rigorous equivalent, including academic coursework and)Tj 0 -1.398 TD -0.0031 Tc -0.032 Tw [(experiential verification. Certification is sometimes synony-)]TJ 0 -1.401 TD -0.0034 Tc 0.085 Tw (mous with licensure, but most often it is not. Certification)Tj T* -0.0036 Tc -0.022 Tw (reflects the embodiment of explicit standards.)Tj /TT7 1 Tf 11 0 0 11 321 515.34 Tm 0.0093 Tc 0.1251 Tw [(What )12.1(A)8.4(r)33.8(e S)28.4(tandar)33.8(ds of Practice for Certification?)]TJ /TT2 1 Tf 10 0 0 10 339 495.66 Tm -0.0095 Tc -0.062 Tw (Standards reflect both scientifically validated knowledge)Tj -1.8 -1.401 TD -0.0036 Tc 0.0916 Tw (and the manner in which this knowledge is translated into)Tj T* -0.0037 Tc -0.035 Tw (practice. Such validated knowledge is derived from rigorous)Tj 0 -1.398 TD -0.0034 Tc 0 Tw (research, based in scientific traditions, including both quan-)Tj 0 -1.401 TD 0.0038 Tc 0.125 Tw (titative and qualitative designs. Standards of practice are)Tj T* -0.0034 Tc -0.0431 Tw (widely recognized within a given field. Recognition is based)Tj 0 -1.398 TD -0.0032 Tc 0.0206 Tw [(on the acceptance of the results of rigorous scientific study)59.8(.)]TJ 0 -1.401 TD -0.0035 Tc 0.0978 Tw (Best practices are built upon the foundation of these stan-)Tj T* -0.0032 Tc 0.0531 Tw (dards. Effective interventions are most likely to be assured)Tj 0 -1.398 TD -0.0034 Tc 0.0808 Tw [(when providers engage only in best practice interventions.)]TJ 0 -1.401 TD -0.0394 Tw (That is possible only when trauma interventionists have pro-)Tj T* -0.0031 Tc 0.0116 Tw (ficiency in the recognized standards of practice.)Tj 1.8 -1.998 TD -0.004 Tc -0.0623 Tw (Among the standards of practice in the field of traumatic)Tj -1.8 -1.401 TD -0.0035 Tc -0.0381 Tw (stress, for example, is knowledge in the following areas:)Tj 1.2 -2.001 TD -0.0039 Tc -0.018 Tw [()-1453.8(Common symptoms of traumatic response including)]TJ 1.8 -1.398 TD -0.0019 Tc 0.125 Tw (how these symptoms appear early on and develop)Tj 0 -1.401 TD -0.0105 Tc -0.06 Tw (over time.)Tj -1.8 -2.001 TD -0.0034 Tc 0.0493 Tw [()-1453.3( )49.9(A)58.8( variety of interventions aimed toward mitigating)]TJ 1.8 -1.398 TD -0.0028 Tc 0.0712 Tw (the symptoms of early stress, acute stress, and also)Tj 0 -1.401 TD -0.0036 Tc 0.0717 Tw (chronic or posttraumatic stress.)Tj -1.8 -2.001 TD -0.0028 Tc 0.1235 Tw [()-1452.7(The ecology or systemic dynamics that support or)]TJ 1.8 -1.398 TD -0.0031 Tc 0.005 Tw [(thwart recovery)59.9(.)]TJ -1.8 -2.001 TD -0.0037 Tc -0.045 Tw [()-1453.6(Methods of supporting natural resilience in individu-)]TJ 1.8 -1.401 TD -0.0141 Tw (als as well as organizations and communities.)Tj -1.2 -1.998 TD -0.0033 Tc 0.0569 Tw (In addition, there are standards of practice for special-)Tj -1.8 -1.401 TD 0.0679 Tw [(ized interventions. )50.7(Although there may be some mutuality)59.7(,)]TJ T* -0.0034 Tc 0.0519 Tw (the standards of practice for crisis intervention include dif-)Tj 0 -1.398 TD -0.0036 Tc -0.0512 Tw (ferent components than the standards of practice for victims)Tj ET endstream endobj 274 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 276 0 obj << /Length 9323 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.0813 Tw [(64 )]TJ /TT3 1 Tf 2.1712 0 TD -0.0053 Tc (Sanders Trauma Certification and the Pledge of Excellence)Tj /TT2 1 Tf 10 0 0 10 54 722.64 Tm -0.0033 Tc 0.0415 Tw (advocates. The standards of practice for psychological first)Tj 0 -1.398 TD -0.0036 Tc -0.0169 Tw (aid include different components than the standards of prac-)Tj 0 -1.401 TD -0.0034 Tc -0.016 Tw [(tice for cognitive-behavioral exposure therapy)62.6(. Practitioners)]TJ T* 0.0366 Tw (should also be aware of the difference between crisis inter-)Tj 0 -1.398 TD -0.003 Tc -0.0213 Tw (ventions, which are simply support services, and actual psy-)Tj 0 -1.401 TD 0.0098 Tc 0.125 Tw (chological treatments offered under the broad banner of)Tj T* -0.0026 Tc 0.0709 Tw [(psychotherapy)63.4(. In this way)63.4(, we can see that there are stan-)]TJ 0 -1.398 TD -0.0031 Tc 0.0561 Tw (dards for a variety of trauma interventions. There are stan-)Tj 0 -1.401 TD -0.0033 Tc 0.11 Tw (dards for crisis intervention, for brief treatment strategies,)Tj T* -0.0036 Tc 0.0069 Tw (and for longer term treatment paradigms. Standards also in-)Tj 0 -1.398 TD 0.0186 Tc 0.125 Tw (clude proven methods of prevention of acute stress re-)Tj 0 -1.401 TD 0.0455 Tc (sponses, secondary stress responses, and exhaustion)Tj T* -0.0036 Tc 0.0378 Tw (brought about by empathic involvement with trauma survi-)Tj 0 -1.398 TD -0.0002 Tc 0.125 Tw (vors. Trauma certifications represent competence in stan-)Tj 0 -1.401 TD -0.0031 Tc -0.0445 Tw (dards and also necessarily reflect that the holder is proficient)Tj T* -0.0153 Tc -0.0624 Tw [(in a specific modality or a combination of modalities of trauma)]TJ 0 -1.398 TD 0.0015 Tc 0 Tw (intervention.)Tj 1.8 -2.001 TD -0.0034 Tc 0.0514 Tw (As knowledge is always increasing, standards of prac-)Tj -1.8 -1.401 TD -0.0036 Tc 0.0089 Tw (tice can best be viewed as evolving. Such evolution implies)Tj 0 -1.398 TD -0.0034 Tc 0.0706 Tw [(that standards need to be updated regularly)62.6(. )17.6(Those holding)]TJ 0 -1.401 TD -0.0033 Tc 0.0088 Tw (to certain standards of practice must constantly update their)Tj T* -0.0075 Tc -0.0622 Tw (knowledge and skills through continuing education and train-)Tj 0 -1.398 TD -0.0109 Tc -0.0625 Tw (ing programs. Maintaining the most current standards of prac-)Tj 0 -1.401 TD -0.0034 Tc 0.0412 Tw [(tice suggests that a person)50.6(s certifications are most current,)]TJ T* -0.0024 Tc 0.125 Tw (accurate, and rigorous. Certifications should contain a re-)Tj 0 -1.398 TD -0.0037 Tc 0.1 Tw (quirement for at least a minimum of continuing education)Tj 0 -1.401 TD -0.0033 Tc 0.035 Tw (hours in order to verify ongoing training and updated prac-)Tj T* -0.0036 Tc -0.05 Tw (tice parameters.)Tj /TT7 1 Tf 11 0 0 11 54 305.34 Tm 0.0121 Tc 0.1249 Tw [(Who Determines S)31.2(tandar)28.5(ds for Certification?)]TJ /TT2 1 Tf 10 0 0 10 72 285.66 Tm -0.002 Tc 0.125 Tw (In deconstructing certifications, it becomes necessary)Tj -1.8 -1.401 TD -0.0032 Tc 0.0769 Tw (for us to review carefully the standards, requirements, and)Tj T* -0.0034 Tc 0.0184 Tw (nature of the accrediting bodies that support a given certifi-)Tj 0 -1.398 TD -0.0037 Tc 0.0278 Tw (cation. Certain standards have been determined based upon)Tj 0 -1.401 TD -0.0034 Tc 0.1165 Tw (academic content and specific types of supervised experi-)Tj T* -0.003 Tc 0.125 Tw (ences. These standards are developed by accrediting bod-)Tj 0 -1.398 TD -0.006 Tc -0.0625 Tw (ies. Determining the credibility of a specific accrediting body)Tj 0 -1.401 TD -0.0034 Tc 0.0921 Tw (becomes a vital task. Such terms as )Tj /TT7 1 Tf 14.91 0 TD -0.004 Tc 0.095 Tw (accreditation council)Tj /TT2 1 Tf 8.541 0 TD 0 Tc 0 Tw (,)Tj /TT7 1 Tf -23.451 -1.401 TD -0.0043 Tc (authentication)Tj /TT2 1 Tf 5.721 0 TD 0.001 Tc (, )Tj /TT7 1 Tf 0.528 0 TD -0.0042 Tc 0.035 Tw (quality assurance)Tj /TT2 1 Tf 7.05 0 TD -0.0028 Tc (, and )Tj /TT7 1 Tf 2.25 0 TD -0.0045 Tc 0 Tw (accrediting)Tj /TT2 1 Tf 4.512 0 TD 0 Tc ( )Tj /TT7 1 Tf 0.285 0 TD -0.0057 Tc (commis-)Tj -20.346 -1.398 TD -0.0042 Tc (sion )Tj /TT2 1 Tf 1.86 0 TD -0.0027 Tc -0.045 Tw (are used readily by those being recognized as well as by)Tj -1.86 -1.401 TD -0.0036 Tc -0.025 Tw (those organizations that are commonly acknowledged as ac-)Tj T* -0.0037 Tc 0.0925 Tw (crediting bodies. These accrediting organizations uphold a)Tj 0 -1.398 TD -0.0035 Tc 0.0519 Tw (high standard and require that certificate holders meet spe-)Tj 0 -1.401 TD -0.0108 Tc -0.061 Tw (cific criteria for certification. The )Tj /TT7 1 Tf 12.951 0 TD -0.0127 Tc 0 Tw (process)Tj /TT2 1 Tf 2.97 0 TD -0.0117 Tc -0.0633 Tw [( of being recognized)]TJ -15.921 -1.401 TD -0.0031 Tc 0.0227 Tw (also must be scrutinized in order to ascertain the credibility)Tj 0 -1.398 TD -0.0057 Tc -0.0621 Tw [(of a given accrediting body)66.3(. In the broader academic commu-)]TJ 25.5 64.698 TD -0.0033 Tc -0.0258 Tw [(nity)59.7(, there are some accrediting or)17.7(ganizations with low stan-)]TJ 0 -1.398 TD -0.0035 Tc -0.0407 Tw (dards; these organizations are not recognized by mainstream)Tj 0 -1.401 TD -0.0039 Tc -0.043 Tw (academia, government commissions, or other organizational)Tj T* -0.0035 Tc 0.11 Tw (bodies of like vocation. Therefore, accrediting bodies that)Tj 0 -1.398 TD 0.0106 Tw (develop standards of practice that reflect the competence of)Tj 0 -1.401 TD -0.0032 Tc 0.1133 Tw (those seeking certification necessarily must be )Tj /TT7 1 Tf 19.356 0 TD -0.0049 Tc 0 Tw (recognized)Tj /TT2 1 Tf -19.356 -1.401 TD -0.0035 Tc -0.0532 Tw (by academic and governmental bodies that uphold high prin-)Tj 0 -1.398 TD -0.0054 Tc 0 Tw (ciples.)Tj 1.8 -2.001 TD -0.0022 Tc 0.125 Tw (Standards for certifications that represent an accurate)Tj -1.8 -1.401 TD -0.0036 Tc 0.085 Tw (claim of competence must be developed by organizational)Tj 0 -1.398 TD -0.0032 Tc 0.0045 Tw (bodies that are recognized widely as leaders in their respec-)Tj 0 -1.401 TD -0.0034 Tc 0.0178 Tw [(tive fields. )50.5(Accrediting bodies generally conduct their work)]TJ T* -0.0039 Tc 0.083 Tw (through boards, commissions, and/or working committees.)Tj 0 -1.398 TD -0.0229 Tw (These working groups are composed of professionals drawn)Tj 0 -1.401 TD -0.0035 Tc -0.0029 Tw (from the field of practice that reflects the purpose for which)Tj T* -0.0033 Tc 0.0806 Tw (the body was organized. Those accrediting bodies that de-)Tj 0 -1.398 TD -0.0014 Tc 0.125 Tw (velop and promote trauma certifications, for instance, are)Tj 0 -1.401 TD -0.0044 Tc -0.0625 Tw (made up of professionals in the field of traumatic stress inter-)Tj T* -0.0036 Tc 0.0481 Tw [(vention. It would make good sense that these professionals)]TJ 0 -1.398 TD -0.0032 Tc 0.1133 Tw (reflect the specializations represented by the certifications)Tj 0 -1.401 TD -0.0034 Tc 0.0925 Tw (offered. Once again, this underscores the need for explicit)Tj T* -0.0031 Tc -0.0037 Tw (standards for particular types of trauma work, developed by)Tj 0 -1.398 TD -0.0037 Tc 0.04 Tw (those professionals trained )Tj /TT7 1 Tf 10.935 0 TD -0.0075 Tc 0 Tw (and)Tj /TT2 1 Tf 1.485 0 TD -0.0035 Tc 0.04 Tw [( experienced in that specific)]TJ -12.42 -1.401 TD -0.0344 Tw (context and paradigm. Formal training is not enough; practi-)Tj T* -0.0048 Tc -0.0625 Tw (cal experience is imperative for members of trauma certifica-)Tj 0 -1.398 TD -0.0035 Tc 0.015 Tw (tion boards. The members of the certification board need to)Tj 0 -1.401 TD -0.0029 Tc -0.0299 Tw [(legitimately hold the certification that they of)18.1(fer)51.1(.)]TJ /TT7 1 Tf 11 0 0 11 309 319.35 Tm 0.0115 Tc 0.1258 Tw [(How is Competence T)85.1(owar)27.9(d S)27.9(tandar)27.9(ds Measur)30.6(ed?)]TJ 10 0 0 10 327 299.64 Tm 0 Tc 0 Tw (S)Tj /TT2 1 Tf 0.495 0 TD -0.0034 Tc 0.0536 Tw (tandards are determined at the accreditation level, al-)Tj -2.295 -1.398 TD -0.0037 Tc -0.014 Tw (though whether one has reached and is able to show compe-)Tj 0 -1.401 TD 0.0581 Tc 0.125 Tw (tence toward standards in practice requires further)Tj T* -0.0074 Tc -0.0622 Tw (verification. In addition to providing verification of extensive)Tj 0 -1.398 TD -0.0026 Tc 0.125 Tw (and appropriate training, there are three different ways to)Tj 0 -1.401 TD -0.0039 Tc -0.0307 Tw (determine whether standards have been reached and embod-)Tj T* -0.006 Tc -0.0623 Tw (ied in practice: These include an oral and/or written examina-)Tj 0 -1.398 TD -0.0034 Tc 0.0911 Tw (tion, a report from a supervisor with field experience, and)Tj 0 -1.401 TD 0.0087 Tw (letters of recommendation by professionals in the field who)Tj T* -0.0033 Tc -0.0261 Tw (have worked with the individual in question testifying to the)Tj 0 -1.398 TD -0.0035 Tc 0.1251 Tw [(person)50.5(s competence. )17.6(There are limits to the guarantee of)]TJ 0 -1.401 TD -0.0032 Tc -0.0316 Tw [(certification. )53.9(A)59( test, for example, whether oral or written, re-)]TJ T* -0.0033 Tc 0.0365 Tw [(flects only a moment in time. )50.7(A)58.9( rigorous test of knowledge)]TJ 0 -1.398 TD -0.0035 Tc 0.0367 Tw [(and practice infers the likelihood that the individual who is)]TJ 0 -1.401 TD -0.0031 Tc -0.0045 Tw (able to pass the test will portray competence in their profes-)Tj T* -0.0035 Tc 0 Tw (sional practice.)Tj ET endstream endobj 277 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 279 0 obj << /Length 9282 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (65)Tj /TT2 1 Tf 10 0 0 10 84 722.64 Tm -0.0032 Tc 0.0156 Tw (Another method that may help to insure competency is)Tj -1.8 -1.398 TD -0.0034 Tc -0.0014 Tw (the requirement for newly trained professional and parapro-)Tj 0 -1.401 TD -0.0037 Tc -0.0217 Tw (fessional crisis intervention or stress management personnel)Tj T* -0.0034 Tc 0.041 Tw (to participate on a crisis response team under the direct su-)Tj 0 -1.398 TD -0.0035 Tc -0.0123 Tw (pervision of a mental health professional who is qualified in)Tj 0 -1.401 TD 0.0125 Tc 0.125 Tw (traumatic stress management. The newly trained person)Tj T* -0.0037 Tc 0.0978 Tw [(should continue to work under supervision until he or she)]TJ 0 -1.398 TD -0.0034 Tc -0.0494 Tw (gains sufficient experience to be signed off by the supervi-)Tj 0 -1.401 TD -0.0036 Tc 0.0657 Tw (sor as a crisis intervention or traumatic stress management)Tj T* -0.0037 Tc -0.0317 Tw [(provider)50.3(.)-6.6( )17.5(This variation on a certification process falls under)]TJ 0 -1.398 TD -0.0036 Tc 0.1069 Tw (the second and third methods of certification as described)Tj 0 -1.401 TD 0.0125 Tc 0 Tw (above.)Tj /TT7 1 Tf 11 0 0 11 66 535.35 Tm 0.0129 Tc 0.1253 Tw [(Paucity of Pr)32(oof)]TJ /TT2 1 Tf 10 0 0 10 84 515.64 Tm -0.0032 Tc -0.0415 Tw (Not all certifying bodies have a method in place to mea-)Tj -1.8 -1.398 TD -0.0037 Tc 0.1 Tw [(sure an applicant)50.3(s competence to meet standards of prac-)]TJ 0 -1.401 TD -0.0007 Tc 0.125 Tw (tice. Some certifying bodies have adopted the practice of)Tj T* -0.0037 Tc 0.0764 Tw (grandfathering those working in a particular field, based)Tj 0 -1.398 TD 0.0058 Tc 0.125 Tw (simply upon the fact that they have worked in the field,)Tj 0 -1.401 TD -0.0015 Tc (whether or not they have demonstrated verifiable compe-)Tj T* -0.0035 Tc -0.0542 Tw (tence. Grandfathering enables professionals to obtain certifi-)Tj 0 -1.398 TD 0.0002 Tc 0.125 Tw (cation with only general forms of proof. Some certifying)Tj 0 -1.401 TD -0.0053 Tc -0.0622 Tw (bodies grant certification upon participation in a time-limited)Tj T* -0.0107 Tc -0.0623 Tw [(seminar)49.3(. For example, training that takes place on a local level)]TJ 0 -1.398 TD 0.002 Tc 0.125 Tw (often is conducted in a 2-day seminar with no follow-up)Tj 0 -1.401 TD -0.0037 Tc -0.0276 Tw [(method of measuring competence. )53.5(A)58.5( few of the trainers who)]TJ T* -0.0035 Tc 0.05 Tw (conduct some of these seminars may not possess extensive)Tj 0 -1.398 TD -0.0371 Tw [(knowledge and experience in trauma work. )50.5(As a result, inac-)]TJ 0 -1.401 TD -0.014 Tc -0.0623 Tw (curate information may be presented or mistakes may be made)Tj T* -0.0019 Tc 0.125 Tw (in the training offered on certain intervention procedures.)Tj 0 -1.398 TD -0.0034 Tc -0.005 Tw (Although some certifying bodies might base their criteria in)Tj 0 -1.401 TD -0.003 Tc 0.0994 Tw (recognized standards of practice, they lack any method of)Tj T* -0.0037 Tc 0.0412 Tw (measuring competence. This suggests that it would be pos-)Tj 0 -1.398 TD 0.0023 Tc 0.125 Tw (sible to obtain a certification without actually possessing)Tj 0 -1.401 TD -0.0036 Tc 0.0043 Tw (competence to practice up to current standards. Unqualified)Tj T* -0.005 Tc -0.0622 Tw (instructors compromise the accuracy of training to standards.)Tj 0 -1.398 TD -0.0036 Tc -0.0044 Tw [(Additionally)59.4(, without some method of evaluating a person)50.4(s)]TJ 0 -1.401 TD -0.0034 Tc 0.0211 Tw (competence, it would be difficult for the public to ascertain)Tj T* -0.0027 Tc -0.025 Tw (the quality of a certification.)Tj 1.8 -1.998 TD -0.0037 Tc 0.0315 Tw (Note well that even some of those who can prove high)Tj -1.8 -1.401 TD 0 Tc 0.125 Tw (levels of academic achievement, including the passing of)Tj T* -0.0037 Tc 0.0792 Tw (postgraduate licensure exams and verification of extensive)Tj 0 -1.398 TD -0.0115 Tc -0.0625 Tw (experience, may still actually lack competence. Organizations)Tj 0 -1.401 TD 0.0036 Tc 0.125 Tw (that operate at the highest levels of professional practice)Tj T* -0.0035 Tc -0.0121 Tw [(should, however)35.5(, still strongly promote multiple methods of)]TJ 0 -1.398 TD -0.0032 Tc 0.025 Tw [(assuring competence to the best of their ability)59.8(.)]TJ 27.3 64.698 TD -0.0026 Tc 0.1118 Tw [(T)74.2(o)0( this end, it is the policy of the four key traumatic)]TJ -1.8 -1.398 TD -0.0037 Tc 0.0894 Tw [(stress or)17.3(ganizations mentioned above, that is, the )50.4(Associa-)]TJ 0 -1.401 TD -0.0086 Tc -0.0622 Tw (tion of Traumatic Stress Specialists, National Organization of)Tj T* -0.0182 Tc -0.0625 Tw [(V)65(ictims )50.8(Assistance, International Critical Incident S)14.8(tress Foun-)]TJ 0 -1.398 TD -0.0171 Tc -0.0623 Tw [(dation, and )49.1(American )52.1(Academy of Experts in )13.1(T)38.7(raumatic S)18.9(tress,)]TJ 0 -1.401 TD -0.0037 Tc 0.1107 Tw (to encourage their members to pursue appropriate creden-)Tj T* -0.0069 Tc -0.0621 Tw (tials and accreditation before initiating crisis intervention and)Tj 0 -1.398 TD -0.004 Tc 0.0683 Tw [(stress management work. )50(All four or)17(ganizations encourage)]TJ 0 -1.401 TD -0.0035 Tc 0.043 Tw (cross-training and gaining additional accreditations beyond)Tj T* -0.0043 Tc -0.0625 Tw [(their own. Finally)58.7(, all four subscribe to the principle that any-)]TJ 0 -1.398 TD -0.0036 Tc 0.0164 Tw (one who provides either crisis intervention support services)Tj 0 -1.401 TD -0.0033 Tc 0.0991 Tw (or psychological treatment after traumatic events, whether)Tj T* -0.0003 Tc 0.125 Tw [(they are mental health professionals or paraprofessionals,)]TJ 0 -1.398 TD -0.003 Tc 0.0016 Tw (should be properly certified.)Tj /TT7 1 Tf 11 0 0 11 321 507.36 Tm -0.0016 Tc 0.126 Tw [(What)123.9(s In a Name?)]TJ /TT2 1 Tf 10 0 0 10 339 487.65 Tm -0.0028 Tc -0.06 Tw (There are basically three types of certification offered in)Tj -1.8 -1.401 TD -0.0029 Tc 0.049 Tw [(the field of trauma work today)63.1(. )15(The first type, which I will)]TJ 0 -1.398 TD -0.003 Tc -0.02 Tw (refer to as )Tj /TT7 1 Tf 4.155 0 TD -0.0038 Tc (limited attestation)Tj /TT2 1 Tf 7.161 0 TD -0.0033 Tc -0.0212 Tw [( certification, requires an appli-)]TJ -11.316 -1.401 TD -0.0035 Tc 0.0671 Tw (cation with limited or generalized verification. The second)Tj T* -0.0093 Tc 0 Tw (type, )Tj /TT7 1 Tf 2.106 0 TD -0.013 Tc (certificate)Tj /TT2 1 Tf 3.915 0 TD -0.0128 Tc -0.062 Tw [( certification, requires short-term training with)]TJ -6.021 -1.398 TD -0.0032 Tc -0.025 Tw (no supervised experience. The third type,)Tj /TT7 1 Tf 16.269 0 TD -0.0043 Tc [( rigorous)]TJ /TT2 1 Tf 3.636 0 TD -0.0033 Tc -0.03 Tw [( certifica-)]TJ -19.905 -1.401 TD -0.0035 Tc 0.0157 Tw [(tion, requires extensive training and course work, including)]TJ T* -0.0034 Tc -0.0573 Tw [(examinations, supervised experience, and references. )50.8(Any of)]TJ 0 -1.398 TD -0.0027 Tc -0.046 Tw (these types of certification may claim titles that may serve to)Tj 0 -1.401 TD -0.0031 Tc -0.0106 Tw (suggest something other than what they actually reflect. For)Tj T* 0.0037 Tc 0.125 Tw (example, the title board-certified suggests rigorous ad-)Tj 0 -1.398 TD -0.0035 Tc 0.0629 Tw (vanced training, often at the postgraduate fellowship level,)Tj 0 -1.401 TD -0.0061 Tc -0.0625 Tw [(assessment through written exam, and board review)56.9(.)0.4( Some of)]TJ T* -0.0036 Tc 0.0243 Tw (the more rigorous board certifications require advanced de-)Tj 0 -1.398 TD 0.0981 Tw (grees from programs of study that have been preapproved)Tj 0 -1.401 TD -0.0029 Tc 0.0912 Tw [(by the board. )33.1(Y)104.3(et, in the field of trauma, one can obtain a)]TJ T* -0.0035 Tc -0.015 Tw (board-level certification through a process that is equivalent)Tj 0 -1.398 TD -0.0031 Tc 0.06 Tw (to the )Tj /TT7 1 Tf 2.601 0 TD -0.0039 Tc (limited attestation)Tj /TT2 1 Tf 7.239 0 TD -0.0033 Tc 0.0612 Tw [( type. Once again, communicating)]TJ -9.84 -1.401 TD -0.0034 Tc -0.0595 Tw (competence to the public may be impaired through the use of)Tj T* -0.0035 Tc 0.049 Tw (such confusing language. There is also a lack of means for)Tj 0 -1.398 TD -0.0088 Tw (ascertaining the differences between )Tj /TT7 1 Tf 14.661 0 TD -0.004 Tc 0 Tw (certificate)Tj /TT2 1 Tf 4.014 0 TD -0.0035 Tc -0.01 Tw [( certification)]TJ -18.675 -1.401 TD -0.0066 Tc 0 Tw (and )Tj /TT7 1 Tf 1.614 0 TD -0.0079 Tc (rigorous)Tj /TT2 1 Tf 3.39 0 TD -0.0055 Tc -0.0625 Tw [( certification. The former can be achieved over a)]TJ -5.004 -1.401 TD -0.0029 Tc -0.0216 Tw [(period of a week)51.1(s time; the latter may require up to 2 years.)]TJ 0 -1.398 TD -0.0046 Tc 0.0791 Tw [(What)52.4(s in a )]TJ 4.985 0 TD -0.0029 Tc 0.0767 Tw [(name? )51.1(Apparently)63.1(, there can be quite a bit of)]TJ -4.985 -1.401 TD -0.0035 Tc 0.0794 Tw (confusion in a name when various certifications are put to)Tj T* -0.0046 Tc -0.0622 Tw (the test. Certifying organizations should make it clear to their)Tj 0 -1.398 TD -0.0021 Tc 0.125 Tw (constituents and to the public what they mean when they)Tj 0 -1.401 TD -0.0038 Tc 0.0133 Tw (use terms such as certification or board-certified.)Tj ET endstream endobj 280 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 282 0 obj << /Length 5387 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0056 Tc 0.0813 Tw [(66 )]TJ /TT3 1 Tf 2.1712 0 TD -0.0053 Tc (Sanders Trauma Certification and the Pledge of Excellence)Tj /F1 1 Tf 11 0 0 11 54 723.99 Tm -0.0058 Tc 0.0659 Tw (Summary and Recommendations)Tj /TT2 1 Tf 10 0 0 10 72 700.65 Tm -0.0128 Tc -0.0622 Tw [(T)73(o)0( insure that the best possible work in the field of trauma)]TJ -1.8 -1.401 TD -0.0033 Tc -0.0151 Tw [(is being of)17.7(fered to those in the midst of an emer)14.7(gency)59.7(, crisis)]TJ 0 -1.398 TD -0.0037 Tc 0.0322 Tw (interventionists and trauma counselors should seek out cer-)Tj 0 -1.401 TD -0.0032 Tc 0.0378 Tw (tification that best suits the work they are undertaking. Not)Tj T* -0.0034 Tc -0.0037 Tw [(all certifications are equal, however)50.6(. Not all require training)]TJ 0 -1.398 TD -0.0035 Tc 0.0043 Tw (and experience as prerequisites. This article has illuminated)Tj 0 -1.401 TD -0.0054 Tc -0.0621 Tw (four key organizations that have developed certifications that)Tj T* -0.0036 Tc -0.0245 Tw (communicate the highest aptitude and offer a broad range of)Tj 0 -1.398 TD -0.0032 Tc 0.0738 Tw (credentials. It is recommended that all certifying bodies in)Tj 0 -1.401 TD -0.0444 Tw (the field of traumatic stress indicate the type of certifications)Tj T* -0.0029 Tc 0.07 Tw (they are offering and clarify what the requirements are for)Tj 0 -1.398 TD -0.0033 Tc -0.044 Tw [(attaining such certification. )50.7(Additionally)62.7(, crisis intervention-)]TJ 0 -1.401 TD 0.0076 Tc 0.125 Tw (ists and trauma counselors are encouraged to cross-train)Tj T* -0.0034 Tc 0.0106 Tw (and obtain certifications that represent the range of services)Tj 0 -1.398 TD -0.0074 Tc -0.0622 Tw [(that they provide. Indeed, the )52.9(Association of )10.9(T)39.4(raumatic S)16.6(tress)]TJ 0 -1.401 TD -0.0035 Tc 0.1028 Tw (Specialists does not differentiate between levels of educa-)Tj T* -0.0069 Tc -0.0626 Tw [(tion. Rather)38.1(, )47(A)115.3(TSS certifications represent types of work con-)]TJ 0 -1.398 TD -0.0032 Tc -0.0572 Tw (ducted in the field, not a hierarchy of academic achievement.)Tj 0 -1.401 TD -0.003 Tc 0.0639 Tw (Each certification we offer can be attained by anyone who)Tj T* -0.0036 Tc 0.0636 Tw (wishes to demonstrate the prerequisite training and experi-)Tj 0 -1.398 TD 0.0046 Tc 0 Tw (ence.)Tj 1.8 -2.001 TD -0.0033 Tc 0.0243 Tw (Becoming certified not only serves to elevate the work)Tj -1.8 -1.401 TD -0.003 Tc 0.0097 Tw (we do in the eyes of the public and of those we serve, but it)Tj 0 -1.398 TD -0.0036 Tc 0.0856 Tw (is also a method of demonstrating the training and experi-)Tj 0 -1.401 TD -0.0017 Tc 0.125 Tw (ence that paraprofessionals and professionals have under-)Tj T* 0.0032 Tc (taken to assure the highest standards. It is recommended)Tj 0 -1.398 TD 0.0019 Tc (that the level of certification sought be of the rigorous)Tj 25.5 39.198 TD -0.003 Tc 0.0267 Tw (type. Regardless of the type of work undertaken, from peer)Tj 0 -1.398 TD -0.0031 Tc 0.0707 Tw (support to trauma counseling, by paraprofessionals to psy-)Tj 0 -1.401 TD -0.0037 Tc 0.051 Tw (chotherapists, trauma certification communicates that great)Tj T* -0.0032 Tc 0.0072 Tw (care has been taken to protect the public in times of crisis.)Tj /F1 1 Tf 11 0 0 11 388.89 648 Tm 0.021 Tc 0 Tw (REFERENCES)Tj /TT2 1 Tf 10 0 0 10 309 630.66 Tm -0.0036 Tc -0.0016 Tw [(Caplan, G)116.4(.)-0.6( \(1964\). )]TJ /TT7 1 Tf 7.536 0 TD -0.0038 Tc -0.0017 Tw [(Principles of pr)32.2(eventive psychiatry)]TJ /TT2 1 Tf 13.8 0 TD -0.0048 Tc -0.005 Tw (. New)Tj -20.136 -1.401 TD -0.0096 Tc -0.0616 Tw [(Y)103.6(ork: Basic Books.)]TJ -1.2 -1.8 TD -0.0026 Tc -0.008 Tw [(Everly)63.4(, G)117.4(.)0( \(Ed.\). \(1995\). )]TJ /TT7 1 Tf 9.804 0 TD -0.0039 Tc -0.0075 Tw (Innovations in disaster and trauma)Tj -8.604 -1.401 TD -0.0122 Tc -0.0606 Tw [(psychology)53.8(, V)107.8(olume One. )]TJ /TT2 1 Tf 9.84 0 TD -0.0114 Tc -0.0624 Tw [(Ellicott City)63.6(, MD: Chevron Pub-)]TJ -9.84 -1.398 TD -0.004 Tc -0.03 Tw (lishing Corporation.)Tj -1.2 -1.8 TD -0.003 Tc 0.12 Tw (Hartsough, D., & Myers, R.N. \(1985\). )Tj /TT7 1 Tf 16.14 0 TD -0.0043 Tc (Disaster work and)Tj -14.94 -1.401 TD -0.0037 Tc 0.0737 Tw [(mental health: Prevention and control of stress among)]TJ T* -0.004 Tc 0 Tw (workers. )Tj /TT2 1 Tf 3.69 0 TD -0.0016 Tw [(W)93.7(ashington, DC: Substance )53(Abuse and Mental)]TJ -3.69 -1.398 TD -0.0423 Tw [(Health Services )53.2(Administration.)]TJ -1.2 -1.8 TD -0.0037 Tc 0.1141 Tw [(V)112.5(ernber)17.3(g, E.M. \(2002\). Intervention approaches following)]TJ 1.2 -1.401 TD -0.0271 Tc -0.0622 Tw [(disasters. In )51.2(A.M. La Greca, )15.2(W)106.7(.K. Silverman, E.M. )15.2(V)116.1(ernber)11.9(g,)]TJ T* -0.0034 Tc -0.0575 Tw (& M.C. Roberts \(Eds.\), )Tj /TT7 1 Tf 9.306 0 TD -0.0039 Tc -0.0587 Tw (Helping children cope with disas-)Tj -9.306 -1.398 TD -0.004 Tc 0.0279 Tw [(ters and terr)37.2(orism)]TJ /TT2 1 Tf 7.23 0 TD -0.0038 Tc [(.)-6.8( )17.1(W)94(ashington, DC: )50.1(American Psycho-)]TJ -7.23 -1.401 TD -0.004 Tc 0.007 Tw (logical Association.)Tj /TT7 1 Tf 9 0 0 9 444 381.99 Tm -0.0045 Tc -0.0056 Tw [(Received: )-5.6( January 17, 2008)]TJ -2.5833 -1.7767 TD -0.0046 Tc 0.0033 Tw (Revision Received: March 3, 2008)Tj 3.9167 -1.7767 TD -0.0049 Tc -0.0185 Tw (Accepted: March 4, 2008)Tj ET endstream endobj 283 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 285 0 obj << /Length 7414 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (67)Tj /F31 1 Tf 12 0 0 12 151.89 713.4 Tm /Cs14 cs 1 scn /GS1 gs -0.0058 Tc -0.0172 Tw (Emergency Mental Health Updates Jeffrey M. Lating, Editor)Tj ET 0.99 w 1000 M 66.995 732.505 490.51 -28.81 re S BT /TT3 1 Tf 20 0 0 20 139.14 654.99 Tm -0.0134 Tc 0.1375 Tw (Selected Annotated Journal Resources)Tj /TT2 1 Tf 12 0 0 12 190.5 632.64 Tm 0 0 0 1 k /GS2 gs -0.0094 Tc -0.0615 Tw (Jessica R. Rothstein, M.S. and Katie J. Loomis, M.S.)Tj ET 3.99 w 10 M /GS1 gs 66 589.485 m 303 589.485 l S BT /TT1 1 Tf 11 0 0 11 66 570.51 Tm /GS2 gs -0.0035 Tc 0.0683 Tw [(Goodman, R.F)86.5(. & Br)15.6(own, E.J. \(2008\). Service and)]TJ 0 -1.1836 TD 0.0154 Tc 0.125 Tw (science in times of crisis: Developing, planning,)Tj 0 -1.1809 TD -0.0032 Tc 0.0704 Tw (and implementing a clinical research program for)Tj T* -0.0005 Tc 0.1251 Tw [(childr)18.6(en traumatically ber)13.1(eaved after)10.4( 9/1)54(1. )]TJ /TT6 1 Tf 19.0555 0 TD -0.0025 Tc 0 Tw (Death)Tj ET 0.99 w /GS1 gs 66 509.985 m 303 509.985 l S BT 11 0 0 11 66 518.49 Tm /GS2 gs 0.0137 Tc 0.1273 Tw [(S)46.2(tudies, 32,)]TJ /TT1 1 Tf 4.9991 0 TD [( 154-180.)]TJ -4.9991 -3.1227 TD -0.008 Tc 0.1236 Tw [(TYPE OF)27.5( )46.5(A)10(R)27.5(TICLE)]TJ /TT2 1 Tf 14 0 0 14 66 468.15 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 468.15 Tm -0.0085 Tc -0.0625 Tw (Original empirical design: Program development)Tj /TT1 1 Tf 11 0 0 11 66 436.14 Tm 0.0059 Tc 0.1263 Tw [(OBJECTIVES/PURPOSE OF)33.2( )14(THE )47.4(A)10.2(R)27.7(TICLE)]TJ /TT2 1 Tf 14 0 0 14 66 420.15 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 420.15 Tm -0.0035 Tc -0.015 Tw (This article reviews the implementation of a clinical re-)Tj 0 -1.401 TD -0.0038 Tc 0.1042 Tw (search program. 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In addition, bereavement has been)Tj T* -0.0036 Tc 0.0394 Tw (shown to have a sleeper effect at times putting these)Tj 0 -1.398 TD -0.0493 Tw (children at continual risk for later substance abuse prob-)Tj 0 -1.401 TD -0.0037 Tc 0.0992 Tw (lems, interpersonal problems, and the development of)Tj T* -0.0016 Tc 0.125 Tw (personality disorders.)Tj 14 0 0 14 309 274.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 274.65 Tm -0.0038 Tc 0.0107 Tw (Based on this information assessment packets were de-)Tj T* -0.0035 Tc 0.065 Tw (veloped to use with preschoolers, school age children,)Tj 0 -1.398 TD -0.0014 Tc 0.125 Tw (adolescents, and young adults.)Tj 14 0 0 14 309 230.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 230.64 Tm -0.0019 Tc 0.125 Tw (The authors noted a need to gather information from)Tj T* -0.0091 Tc -0.0622 Tw (multiple informants given the research findings that trau-)Tj 0 -1.401 TD -0.0229 Tc (matized children and their families often inaccurately iden-)Tj T* -0.0024 Tc 0.025 Tw (tify their distress.)Tj 14 0 0 14 309 172.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 172.65 Tm 0.0038 Tc 0.125 Tw (Assessment procedures included behavioral observa-)Tj T* -0.0034 Tc -0.0335 Tw (tions, clinical interviews, mental status exams, and self-)Tj 0 -1.398 TD -0.0036 Tc 0.085 Tw (report measures, but the exact procedure varied based)Tj 0 -1.401 TD -0.0038 Tc 0.06 Tw (on age.)Tj 14 0 0 14 309 114.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 114.66 Tm -0.0037 Tc 0.1128 Tw (The authors aimed to capture the developmental con-)Tj T* -0.0034 Tc 0.0007 Tw (tinuum of traumatic bereavement by assessing the chil-)Tj T* -0.0042 Tc 0 Tw (dren )Tj ET 500 w 414.51 -913.36 m 346.95 -913.36 l S BT 10 0 0 10 346.95 86.64 Tm -0.0029 Tc -0.0152 Tw (every six months.)Tj ET endstream endobj 293 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 295 0 obj << /Length 8494 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (69)Tj /TT2 1 Tf 14 0 0 14 66 722.64 Tm 0 Tc ()Tj 10 0 0 10 84 722.64 Tm 0.0183 Tc 0.125 Tw (Assessments were often conducted in the families)Tj 0 -1.398 TD -0.0033 Tc -0.0183 Tw (homes or offices in their local community given the au-)Tj 0 -1.401 TD -0.0046 Tc -0.0624 Tw [(thors desire to respect the families)70.4( privacy)58.4(, the families)]TJ T* -0.0035 Tc 0.1225 Tw (transportation difficulties, and the hardships of single)Tj 0 -1.398 TD -0.0095 Tc -0.06 Tw (family parenting.)Tj 14 0 0 14 66 650.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 650.64 Tm -0.0038 Tc -0.005 Tw (Another challenge of the assessment procedure was the)Tj T* -0.0034 Tc 0.0425 Tw (difficult balance between the need to comprehensively)Tj 0 -1.401 TD -0.0037 Tc -0.0442 Tw (evaluate the children and the additional demands placed)Tj T* -0.0092 Tc -0.0625 Tw [(on the families. Given feedback from families changes to)]TJ 0 -1.398 TD -0.0043 Tc -0.0622 Tw (the assessment protocol were made to make it more con-)Tj 0 -1.401 TD -0.0012 Tc 0 Tw (cise.)Tj 14 0 0 14 66 564.66 Tm 0 Tc ()Tj 10 0 0 10 84 564.66 Tm -0.0035 Tc 0.0595 Tw [(In total, 220 \(43%\) of the children were scheduled for)]TJ T* 0.1224 Tw (initial assessments and of these 204 \(93%\) began the)Tj T* 0.0042 Tc 0.125 Tw (assessment procedure.)Tj 14 0 0 14 66 520.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 520.65 Tm -0.0037 Tc 0.1187 Tw (Of the children who began the procedure, 176 \(86%\))Tj T* -0.0038 Tc 0.0057 Tw (completed while 28 \(14%\) refused or were excluded as)Tj 0 -1.398 TD 0.0333 Tw (their assessments were incomplete.)Tj 14 0 0 14 66 476.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 476.64 Tm -0.0035 Tc -0.0229 Tw (Forty-five \(22%\) of the assessments were conducted on)Tj T* 0.0593 Tw (preschoolers, 149 \(73%\) were conducted on 4-18 year)Tj 0 -1.401 TD -0.0033 Tc -0.0216 Tw (olds, and 9 \(4%\) were conducted on 19-24 year olds.)Tj /TT1 1 Tf 11 0 0 11 66 416.64 Tm 0.0234 Tc 0 Tw (Intervention)Tj /TT2 1 Tf 14 0 0 14 66 400.65 Tm 0 Tc ()Tj 10 0 0 10 84 400.65 Tm -0.0163 Tc -0.0625 Tw (In their literature review of treatment utilized for bereaved)Tj T* -0.0035 Tc 0.03 Tw (children, the authors reported that most were receiving)Tj 0 -1.398 TD 0.0714 Tw (Rogerian or client centered therapy \(CCT\) in commu-)Tj 0 -1.401 TD -0.0074 Tc -0.0619 Tw [(nity-based bereavement programs. However)37.6(, the authors)]TJ T* -0.003 Tc 0.0019 Tw (noted that these types of program have limited efficacy)Tj 0 -1.398 TD 0.0024 Tc 0 Tw (research.)Tj 14 0 0 14 66 314.64 Tm 0 Tc ()Tj 10 0 0 10 84 314.64 Tm -0.0037 Tc 0.1088 Tw (Based on findings of children and adults with trauma)Tj T* -0.0035 Tc -0.0625 Tw (related PTSD, anxiety disorders, depression, and behav-)Tj 0 -1.401 TD -0.0322 Tw (ior problems, parent and child CBT was selected for the)Tj T* -0.0006 Tc 0.125 Tw [(intervention strategy)59.4(.)]TJ 14 0 0 14 66 256.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 256.65 Tm -0.0036 Tc 0.0971 Tw (The treatment intervention consisted of 16 parent and)Tj T* 0.04 Tw (child sessions focusing on traumatic grief. Participants)Tj 0 -1.398 TD -0.0037 Tc 0.0881 Tw (were either given CBT or CCT treatment for children)Tj 0 -1.401 TD -0.0032 Tc 0.0493 Tw [(ages 4-18 years old. However)38.8(, given that the interven-)]TJ T* -0.0046 Tc -0.0621 Tw (tion period overlapped with summer vacations and other)Tj 0 -1.398 TD -0.0002 Tc 0.125 Tw (events, the authors allowed the treatment to be com-)Tj 0 -1.401 TD -0.0036 Tc -0.036 Tw (pleted during a 20 week period.)Tj 14 0 0 14 66 156.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 156.66 Tm -0.0009 Tc 0.125 Tw (Alternative treatment strategies were used for the in-)Tj T* 0.0011 Tc (fants, preschoolers, and young adults ages 19-24 en-)Tj T* -0.0036 Tc -0.0566 Tw (rolled in the program.)Tj 14 0 0 14 66 112.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 112.65 Tm -0.012 Tc -0.0625 Tw (All family members were treated with the same treatment)Tj T* -0.0031 Tc -0.033 Tw (model and by the same clinician.)Tj 14 0 0 14 66 82.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 82.65 Tm -0.0033 Tc 0.125 Tw (The authors indicated their intervention was different)Tj T* 0.1186 Tw (than typical manualized treatments because not all of)Tj 25.5 65.4 TD -0.0093 Tc -0.0625 Tw (their children met criteria for a DSM-IV diagnosis. How-)Tj 0 -1.398 TD 0.0016 Tc 0.1252 Tw [(ever)34.6(, they asserted that because of the recent trauma)]TJ 0 -1.401 TD -0.0035 Tc 0.105 Tw (experience it was appropriate to also include children)Tj T* -0.0037 Tc -0.0356 Tw (with who appeared to be experiencing distress and were)Tj 0 -1.398 TD -0.0035 Tc -0.028 Tw (at risk of developing a problem.)Tj 14 0 0 14 321 650.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 650.64 Tm -0.0033 Tc -0.0262 Tw [(Additionally)59.7(, the authors state that it was challenging to)]TJ T* -0.003 Tc -0.0481 Tw (treat a wide age range of children \(birth to 24 years old\).)Tj /TT1 1 Tf 11 0 0 11 321 604.65 Tm 0.0406 Tc 0 Tw (Research)Tj /TT2 1 Tf 14 0 0 14 321 588.66 Tm 0 Tc ()Tj 10 0 0 10 339 588.66 Tm 0.0048 Tc 0.125 Tw (The findings of the research have been published in)Tj 0 -1.401 TD -0.0035 Tc 0.1031 Tw (other work by the authors \(see Brown and Goodman,)Tj T* -0.0041 Tc 0.0434 Tw (2002; Brown, Goodman, Cohen, & Mannarino, 2004\);)Tj 0 -1.398 TD -0.0034 Tc 0.0337 Tw [(however)38.6(, for this article the author reflected on the de-)]TJ 0 -1.401 TD -0.0008 Tc 0.125 Tw (sign of the research component and its strengths and)Tj T* 0.003 Tc 0 Tw (challenges.)Tj 14 0 0 14 321 502.65 Tm 0 Tc ()Tj 10 0 0 10 339 502.65 Tm -0.001 Tc 0.125 Tw (The research component of the program consisted of)Tj T* -0.0022 Tc (three studies:)Tj 0.6 -1.599 TD -0.0035 Tc -0.0269 Tw [(o)-703.5(Using the first assessment of each child the authors)]TJ 1.2 -1.401 TD -0.0032 Tc 0.0579 Tw (used a cross-sectional design to study the correla-)Tj 0 -1.398 TD -0.0037 Tc -0.0084 Tw (tions of traumatic bereavement.)Tj -1.2 -1.602 TD -0.0035 Tc 0.125 Tw [(o)-703.5(Based on the six month assessments, the authors)]TJ 1.2 -1.398 TD -0.01 Tw (conducted a longitudinal study of the developmen-)Tj 0 -1.401 TD -0.0467 Tw (tal of traumatic bereavement.)Tj -1.2 -1.599 TD -0.004 Tc 0.0658 Tw [(o)-704(Comparing the CBT and CCT intervention strate-)]TJ 1.2 -1.401 TD -0.0036 Tc 0.0883 Tw (gies, the authors conducted a randomized clinical)Tj T* -0.0578 Tw (treatment trial for children exposed to traumatic be-)Tj 0 -1.398 TD -0.0071 Tc 0 Tw (reavement.)Tj 14 0 0 14 321 326.64 Tm 0 Tc ()Tj 10 0 0 10 339 326.64 Tm -0.0035 Tc -0.0307 Tw (Ultimately 140 children \(94%\) in 69 families consented)Tj T* -0.0033 Tc 0.0125 Tw (for research participation in the different studies.)Tj 14 0 0 14 321 296.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 296.64 Tm -0.0038 Tc -0.0079 Tw (When considering the research design, the authors con-)Tj T* -0.0035 Tc 0.0056 Tw (sidered how much the participants desire not to partici-)Tj 0 -1.401 TD -0.0028 Tc 0.125 Tw (pate in research would impact their ability to receive)Tj T* 0.0622 Tw (treatment. Thus they had a three-step process to try to)Tj 0 -1.398 TD -0.0035 Tc 0.0815 Tw (ensure that the families could receive services regard-)Tj 0 -1.401 TD -0.0033 Tc 0.01 Tw (less of their interest in being involved in research.)Tj 14 0 0 14 321 210.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 210.66 Tm -0.0035 Tc -0.0356 Tw (There were few exclusion criteria in the research design)Tj T* 0.0034 Tc 0.1248 Tw [(\(e.g., suicidality)63.4(, psychotic symptoms, and pervasive)]TJ T* 0.0062 Tc 0.125 Tw (developmental disorders\) because the authors focus)Tj 0 -1.398 TD -0.0035 Tc 0.01 Tw (was on meeting the clinical needs of the population.)Tj 14 0 0 14 321 152.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 152.64 Tm -0.0034 Tc -0.0384 Tw (In addition, the authors believed that the number of pro-)Tj T* -0.0031 Tc -0.0145 Tw [(cedures and the use of those with high reliability)62.9(, valid-)]TJ 0 -1.401 TD -0.0026 Tc -0.0109 Tw [(ity)60.4(, and utility)63.4(, ultimately strengthened their findings.)]TJ 14 0 0 14 321 108.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 108.66 Tm -0.0038 Tc -0.0365 Tw (One challenge experienced was the pragmatic and emo-)Tj T* -0.0035 Tc 0.0972 Tw (tional difficulties in getting mothers and caretakers to)Tj T* -0.0037 Tc 0.0363 Tw (return for follow up assessments.)Tj ET endstream endobj 296 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 298 0 obj << /Length 8416 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.1229 Tw [(70 )]TJ /TT3 1 Tf 2.295 0 TD -0.0057 Tc 0.125 Tw (Selected Annotated Journal Resources)Tj /TT1 1 Tf 11 0 0 11 54 722.64 Tm 0.0255 Tc 0 Tw [(CONTRIBUTIONS/IMPLICA)63.7(TIONS)]TJ /TT2 1 Tf 14 0 0 14 54 706.65 Tm 0 Tc ()Tj 10 0 0 10 72 706.65 Tm -0.0035 Tc -0.0078 Tw (According to the authors, an asset of their program was)Tj 0 -1.401 TD 0.0033 Tc 0.125 Tw (that even before potential participants were asked to)Tj 0 -1.398 TD -0.0009 Tc (participate in research they had received support and)Tj 0 -1.401 TD -0.0101 Tc -0.0622 Tw (guidance from the program, portraying the authors com-)Tj T* -0.0033 Tc 0.1193 Tw [(mitment to the community)59.7(. )17.7(They ur)17.7(ged other disaster)]TJ 0 -1.398 TD -0.002 Tc 0.125 Tw (studies researchers to implement these types of prac-)Tj 0 -1.401 TD 0.0035 Tc 0 Tw (tices.)Tj 14 0 0 14 54 606.66 Tm 0 Tc ()Tj 10 0 0 10 72 606.66 Tm -0.0036 Tc 0.0469 Tw (The authors highlighted that one of the most challeng-)Tj T* 0.1056 Tw (ing aspects of their work was to navigate the balance)Tj T* -0.0034 Tc 0.1107 Tw (between theory and practice and the balance between)Tj 0 -1.398 TD -0.0035 Tc 0.01 Tw (research design and clinical service.)Tj 14 0 0 14 54 548.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 548.64 Tm 0.0003 Tc 0.125 Tw (The authors asserted that their findings may work to)Tj T* 0.0185 Tc (change public opinion about disaster studies. They)Tj 0 -1.401 TD -0.0029 Tc 0.023 Tw (hoped that the public may begin to see that these types)Tj T* -0.0035 Tc 0.0743 Tw (of studies can provide clinical value and help develop)Tj 0 -1.398 TD -0.001 Tc 0.125 Tw (future interventions rather than being intrusive or in-)Tj 0 -1.401 TD -0.0038 Tc 0.022 Tw (sensitive as is a common counterargument.)Tj 14 0 0 14 54 462.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 462.66 Tm -0.0034 Tc -0.045 Tw (Furthermore, they suggested that a national trauma-spe-)Tj T* -0.0036 Tc 0.0029 Tw (cific institutional review board would help provide ser-)Tj T* -0.0031 Tc 0.0677 Tw [(vices quickly)62.9(, and being research, in the time of crisis)]TJ 0 -1.398 TD -0.0036 Tc -0.005 Tw (without being held up in traditional institutional review)Tj 0 -1.401 TD -0.0008 Tc 0.1249 Tw (board procedures.)Tj ET 3.99 w /GS1 gs 54 373.005 m 291 373.005 l S BT /TT1 1 Tf 11 0 0 11 54 354 Tm /GS2 gs -0.0034 Tc 0.0766 Tw [(Adams, S.A. & Riggs, S.A. \(2008\). )51.1(An exploratory)]TJ 0 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trainees.)Tj -1.8 -1.599 TD -0.0038 Tc 0.0593 Tw [()-1470.8(The authors defined vicarious traumatization as a cu-)]TJ 1.8 -1.401 TD 0.0028 Tc 0.125 Tw (mulative consequence not specific to any one client,)Tj 0 -1.398 TD -0.0035 Tc 0.0689 Tw (which can be lasting and linked to multiple aspects of)Tj 0 -1.401 TD -0.0034 Tc 0.12 Tw [(the therapist)50.6(s personal and professional life \(p. 26\),)]TJ T* -0.0032 Tc -0.0384 Tw (and can eventually lead to PTSD like symptoms such as)Tj 0 -1.398 TD -0.0147 Tc -0.0621 Tw [(anxiety)60.3(, depression, somatic symptoms, emotional numb-)]TJ 0 -1.401 TD 0.0125 Tc 0.125 Tw (ing or emotional flooding, suspiciousness, intrusive)Tj 25.5 63.399 TD -0.0032 Tc 0.035 Tw [(thoughts, and feelings of vulnerability)59.8(.)]TJ 14 0 0 14 309 706.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 706.65 Tm -0.0036 Tc 0.095 Tw (In addition, the authors investigated whether therapist)Tj 0 -1.401 TD 0.0081 Tc 0.125 Tw (characteristics such as defense style, and a personal)Tj 0 -1.398 TD -0.0034 Tc 0.0357 Tw (history of trauma, would influence the development of)Tj 0 -1.401 TD -0.0049 Tc -0.06 Tw (vicarious reinforcement.)Tj 14 0 0 14 309 648.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 648.66 Tm -0.0036 Tc 0.0343 Tw (The authors believed that trainees with less experience)Tj T* -0.0076 Tc -0.0625 Tw (and less trauma specific-training would be more likely to)Tj T* -0.0063 Tc (experience vicarious traumatization.)Tj 14 0 0 14 309 604.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 604.65 Tm -0.0028 Tc -0.0068 Tw (They also hypothesized that therapists with a history of)Tj T* -0.0085 Tc -0.0622 Tw (trauma would be more vulnerable to experiencing vicari-)Tj 0 -1.398 TD -0.0037 Tc 0.0578 Tw (ous traumatization and would endorse higher levels of)Tj 0 -1.401 TD -0.0035 Tc -0.06 Tw (trauma symptoms.)Tj 14 0 0 14 309 546.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 546.66 Tm 0.0017 Tc 0.125 Tw (In regards to defense style, the authors hypothesized)Tj T* -0.0143 Tc -0.0625 Tw (that therapists that utilized active, problem-focusing strat-)Tj T* -0.009 Tc (egies would experience less vicarious traumatization and)Tj 0 -1.398 TD -0.0036 Tc -0.0075 Tw (report fewer PTSD and other negative symptoms.)Tj 14 0 0 14 309 488.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 488.64 Tm -0.0036 Tc 0.085 Tw (Furthermore, the authors believed that there would be)Tj T* 0.0488 Tw (an interaction between these variables.)Tj /TT1 1 Tf 11 0 0 11 309 442.65 Tm 0.0265 Tc 0 Tw (PROCEDURE)Tj 0 -1.4536 TD 0.0026 Tc (Participants)Tj /TT2 1 Tf 14 0 0 14 309 410.64 Tm 0 Tc ()Tj 10 0 0 10 327 410.64 Tm 0.0003 Tc 0.125 Tw (The authors sent 355 packets to graduate students in)Tj 0 -1.398 TD 0.0155 Tc [(A)9.8(P)90.5(A)56.7( accredited clinical and counseling psychology)]TJ 0 -1.401 TD -0.0036 Tc 0.0268 Tw [(graduate programs at state universities in )14.5(T)73.2(exas.)]TJ 14 0 0 14 309 366.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 366.66 Tm -0.0038 Tc 0.0107 Tw (After excluding information from students who did not)Tj T* -0.0033 Tc -0.0061 Tw (work with trauma clients or who were not currently en-)Tj T* -0.0035 Tc -0.0119 Tw (rolled in a graduate training program, 129 graduate stu-)Tj 0 -1.398 TD -0.0031 Tc 0.0712 Tw [(dents participated in the study)59.9(.)]TJ 14 0 0 14 309 308.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 308.64 Tm -0.0036 Tc 0.0357 Tw (Of these participants 83.7 % were female, 83.5% were)Tj T* -0.0031 Tc -0.053 Tw (Caucasian, and there was a mean age of 31.21 years \()Tj /TT7 1 Tf 20.691 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf -20.691 -1.401 TD -0.0339 Tc -0.06 Tw (= 8.69\).)Tj 14 0 0 14 309 264.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 264.66 Tm 0.0032 Tc 0.125 Tw (Doctoral trainees in counseling psychology made up)Tj T* -0.0187 Tc -0.06 Tw (43.4% \()Tj /TT7 1 Tf 2.979 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.486 0 TD -0.0177 Tc -0.0622 Tw [( = 56\) of the participants, while there were 25.6%)]TJ -3.465 -1.401 TD 0 Tc 0 Tw (\()Tj /TT7 1 Tf 0.33 0 TD (n)Tj /TT2 1 Tf 0.495 0 TD -0.0029 Tc 0.1043 Tw [( =33\) doctoral level trainees in clinical psychology)60.1(,)]TJ -0.825 -1.398 TD -0.0037 Tc 0.0075 Tw (31% \(n = 39\) students in counseling masters programs,)Tj 0 -1.401 TD -0.0033 Tc 0.0175 Tw (and one student pursuing a masters in clinical psychol-)Tj T* 0.012 Tc 0 Tw [(ogy)60(.)]TJ /TT1 1 Tf 11 0 0 11 309 162.66 Tm 0.0233 Tc (Materials)Tj /TT2 1 Tf 14 0 0 14 309 146.64 Tm 0 Tc ()Tj 10 0 0 10 327 146.64 Tm -0.0111 Tc -0.0621 Tw [(Demographic information was gathered such as the num-)]TJ 0 -1.398 TD -0.0034 Tc -0.047 Tw (ber and type of coursework in trauma and the number of)Tj 0 -1.401 TD -0.0038 Tc 0.024 Tw (semesters spent working with trauma patients.)Tj 14 0 0 14 309 102.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 102.66 Tm -0.0034 Tc -0.0443 Tw (The demographic portion also asked trainees if they had)Tj T* -0.0048 Tc -0.0625 Tw (ever been exposed to a trauma including: being involved)Tj ET endstream endobj 299 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 301 0 obj << /Length 9620 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (71)Tj /TT2 1 Tf 10 0 0 10 84 722.64 Tm -0.0035 Tc -0.0206 Tw [(in a natural disaster)35.5(, witnessing or participating in com-)]TJ 0 -1.398 TD -0.0131 Tc -0.0621 Tw (bat, witnessing someone being seriously injured or killed,)Tj 0 -1.401 TD -0.0034 Tc 0.0175 Tw (being a survivor of a violent crime, being a survivor of)Tj T* -0.009 Tc -0.0625 Tw (child physical, sexual, or emotional abuse, being an adult)Tj 0 -1.398 TD -0.0034 Tc -0.043 Tw (survivor of rape or sexual assault, or being involved in a)Tj 0 -1.401 TD -0.0028 Tc 0.0625 Tw (physically abusive relationship.)Tj 14 0 0 14 66 636.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 636.66 Tm -0.0036 Tc 0.0125 Tw (The participants were also administered five subscales,)Tj T* -0.0031 Tc 0.0562 Tw (or 42 items, of the Trauma Symptom Inventory \(TSI\).)Tj T* -0.0048 Tc -0.0624 Tw [(These subscales were: )55.3(Anxious )49.3(Arousal, Intrusive Expe-)]TJ 0 -1.398 TD 0.006 Tc 0.1249 Tw [(riences, Defensive )50.9(A)77.2(voidance, Dissociation, and Im-)]TJ 0 -1.401 TD 0.0303 Tc 0.125 Tw [(paired Self-Reference. The full measure was not)]TJ T* -0.0037 Tc 0.0029 Tw (administered because the authors believed that some of)Tj 0 -1.398 TD -0.0036 Tc 0.07 Tw (the subscales were too broad.)Tj 14 0 0 14 66 536.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 536.64 Tm -0.0031 Tc -0.0261 Tw [(T)73.7(o)0( measure the defense style of the trainee, the Defense)]TJ T* 0.0056 Tc 0.125 Tw (Style Questionnaire \(DSQ\) was used. The DSQ is a)Tj 0 -1.401 TD -0.0084 Tc -0.0622 Tw (widely used self report measure, with 88 items utilizing a)Tj T* -0.0117 Tc -0.062 Tw [(9-point Likert scale. Using this measure)48.3(s manual partici-)]TJ 0 -1.398 TD -0.0036 Tc -0.0125 Tw (pants were classified into the following hierarchies:)Tj 0.6 -1.602 TD -0.0032 Tc 0.114 Tw [(o)-703.2(Defense styles that utilize withdrawal, inhibition,)]TJ 1.2 -1.398 TD -0.0035 Tc -0.0225 Tw (passive aggression, regression, acting out, and pro-)Tj 0 -1.401 TD -0.0054 Tc -0.0621 Tw (jection were labeled the most maladaptive or imma-)Tj T* -0.0012 Tc 0 Tw (ture.)Tj -1.2 -1.599 TD 0.0039 Tc 0.125 Tw [(o)-696.1(An image distorting defense style features split-)]TJ 1.2 -1.401 TD -0.0086 Tc -0.0625 Tw (ting, primitive idealization, and feelings of superior-)Tj 0 -1.398 TD -0.0133 Tc 0 Tw [(ity)64.7(.)]TJ -1.2 -1.602 TD -0.0029 Tc -0.0465 Tw [(o)-702.9(A)0( self-sacrificing defense style is used by individu-)]TJ 1.2 -1.398 TD -0.0035 Tc 0.0583 Tw (als who want to appear kind and helpful to others)Tj 0 -1.401 TD -0.0022 Tc 0.125 Tw (and may engage in acts that can be described as)Tj T* 0.0018 Tc (psuedoaltruistic acts.)Tj -1.2 -1.599 TD -0.0033 Tc 0.0029 Tw [(o)-703.3(Adaptive or mature defense styles are described as)]TJ 1.2 -1.401 TD -0.0038 Tc 0.085 Tw [(those in which individuals engage in humor)35.2(, sup-)]TJ 0 -1.398 TD 0.0475 Tw (pression, and sublimation.)Tj /TT1 1 Tf 11 0 0 11 66 244.65 Tm 0.0242 Tc 0 Tw (Procedure)Tj /TT2 1 Tf 14 0 0 14 66 228.66 Tm 0 Tc ()Tj 10 0 0 10 84 228.66 Tm -0.0039 Tc 0.0721 Tw [(When the authors contacted program directors at )50.1(A)8.4(P)86.1(A)]TJ 0 -1.401 TD -0.0209 Tc -0.0625 Tw (accredited graduate programs, 9 \(PhD = 7, MA = 2\) agreed)Tj T* -0.0035 Tc 0.04 Tw (to distribute the project materials to trainees who were)Tj 0 -1.398 TD -0.0034 Tc 0.0384 Tw [(seeing clients as a part of their practicum or internship)]TJ 0 -1.401 TD -0.0064 Tc -0.0625 Tw (during the fall of 2002.)Tj 14 0 0 14 66 156.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 156.66 Tm -0.0035 Tc 0.05 Tw (The participants packet contained a description of the)Tj T* -0.0032 Tc -0.0026 Tw [(study)62.8(, a consent form, a questionnaire about their train-)]TJ T* -0.0035 Tc -0.0083 Tw (ing experience, the TSI, the DSQ, and a stamped return)Tj 0 -1.398 TD 0.0051 Tc 0 Tw (envelope.)Tj /TT1 1 Tf 11 0 0 11 321 722.64 Tm 0.0154 Tc [(RESUL)83.6(TS)]TJ /TT2 1 Tf 14 0 0 14 321 706.65 Tm 0 Tc ()Tj 10 0 0 10 339 706.65 Tm -0.0058 Tc -0.0622 Tw (Fifty participants \(38.7%\) endorsed a history of personal)Tj 0 -1.401 TD -0.0169 Tc 0 Tw (trauma.)Tj 14 0 0 14 321 676.65 Tm 0 Tc ()Tj 10 0 0 10 339 676.65 Tm -0.0032 Tc -0.0371 Tw (Ninety-six \(74.3%\) indicated that they had some formal)Tj T* -0.0182 Tc -0.0622 Tw (trauma specific training, with 46 participants \(35.6%\) stat-)Tj 0 -1.398 TD 0.0003 Tc 0.125 Tw (ing that their training was substantial and 50 partici-)Tj 0 -1.401 TD -0.0034 Tc -0.0557 Tw (pants \(38.7\) related that there training was minimal.)Tj 14 0 0 14 321 618.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 618.66 Tm -0.0053 Tc -0.0623 Tw (Experience working with trauma ranged from 0 to 38 se-)Tj T* -0.0047 Tc -0.06 Tw (mesters \()Tj /TT7 1 Tf 3.54 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.819 0 TD -0.003 Tc -0.0617 Tw [( = 4.86, )]TJ /TT7 1 Tf 3.105 0 TD -0.0162 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.206 0 TD -0.0045 Tc -0.0619 Tw [( = 6.09\). However)40.5(, 52 participants)]TJ -8.67 -1.401 TD -0.0034 Tc 0.045 Tw (\(40%\) indicated that they had worked with trauma cli-)Tj 0 -1.398 TD -0.0035 Tc 0.002 Tw (ents for two or fewer semesters.)Tj 14 0 0 14 321 560.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 560.64 Tm -0.0056 Tc -0.0625 Tw (Mean results from the TSI were not clinically significant)Tj T* -0.0034 Tc -0.01 Tw (with only 8-15% of the participants scoring higher than)Tj 0 -1.401 TD -0.0035 Tc -0.0561 Tw [(the clinical cut-of)17.5(f score on each subscale. However)38.5(, the)]TJ T* -0.0594 Tw (authors indicate that 31% of the sample had an elevation)Tj 0 -1.398 TD -0.0037 Tc 0.001 Tw (on one or more TSI subscale.)Tj 14 0 0 14 321 488.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 488.64 Tm -0.0036 Tc -0.0575 Tw (On the DSQ, due to low cell counts the maladaptive \()Tj /TT7 1 Tf 20.655 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.064 Tc ( =)Tj -21.15 -1.398 TD -0.0107 Tc -0.0613 Tw (3\) and image distorting \()Tj /TT7 1 Tf 9.381 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.489 0 TD -0.0105 Tc -0.063 Tw [( = 6\), categories were collapsed)]TJ -9.87 -1.401 TD -0.003 Tc 0.1188 Tw [(into one defense style, as the authors indicate is sup-)]TJ T* -0.002 Tc 0.0675 Tw [(ported by theory)61(.)]TJ 14 0 0 14 321 430.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 430.65 Tm -0.0037 Tc 0.1183 Tw (Thus participants were categorized into the following)Tj T* -0.0058 Tc -0.0625 Tw (three defense styles: maladaptive/image-distorting 7.0%)Tj 0 -1.398 TD 0 Tc 0 Tw (\()Tj /TT7 1 Tf 0.33 0 TD (n)Tj /TT2 1 Tf 0.495 0 TD -0.0048 Tc -0.062 Tw [( = 9\), 51.2% self-sacrificing \()]TJ /TT7 1 Tf 11.355 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.005 Tc -0.062 Tw [( = 66\), and 41.8% adap-)]TJ -12.675 -1.401 TD -0.0073 Tc -0.06 Tw (tive \()Tj /TT7 1 Tf 1.98 0 TD 0 Tc 0 Tw (n)Tj /TT2 1 Tf 0.495 0 TD -0.0078 Tc -0.0625 Tw [( = 54\).)]TJ 14 0 0 14 321 372.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 372.66 Tm -0.0113 Tc -0.0625 Tw (As for demographic variables, ethnicity was significantly)Tj 0 -1.401 TD -0.0036 Tc 0.062 Tw (correlated with TSI intrusive experiences )Tj /TT7 1 Tf 16.905 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0032 Tc 0.0634 Tw [( = .01 with)]TJ -17.4 -1.401 TD -0.0051 Tc -0.0625 Tw (participants who were ethnic minorities endorsing lower)Tj 0 -1.398 TD -0.0035 Tc -0.0462 Tw (levels of intrusive experiences. There were no other sig-)Tj 0 -1.401 TD -0.0037 Tc -0.056 Tw (nificant differences between the demographic variables.)Tj 14 0 0 14 321 300.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 300.66 Tm -0.0041 Tc -0.012 Tw [(Using a MANOV)124.9(A)58.1( a main ef)16.9(fect was found for defense)]TJ T* -0.0096 Tc -0.0612 Tw (style and personal trauma \()Tj /TT7 1 Tf 10.329 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.492 0 TD -0.011 Tc -0.0618 Tw [( < .0001\). Using an )50.2(ANOV)130(A,)]TJ -10.821 -1.401 TD -0.0149 Tc -0.0622 Tw (there were significant findings for all of the trauma scales:)Tj 0 -1.398 TD -0.0038 Tc 0.09 Tw (anxious arousal \()Tj /TT7 1 Tf 6.951 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0032 Tc 0.092 Tw [( = .007\), intrusive experiences \()]TJ /TT7 1 Tf 13.053 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD 0.092 Tc ( =)Tj -20.994 -1.401 TD -0.0035 Tc 0.0567 Tw [(.04\), defensive avoidance \()]TJ /TT7 1 Tf 10.881 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0032 Tc 0.0563 Tw [( = .001\), dissociation \()]TJ /TT7 1 Tf 9.159 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD 0.056 Tc ( =)Tj -21.03 -1.401 TD -0.0145 Tc -0.0616 Tw (.001\), dissociation \(p )Tj /TT7 1 Tf 8.175 0 TD 0 Tc 0 Tw (=)Tj /TT2 1 Tf 0.654 0 TD -0.0149 Tc -0.0625 Tw [( .001\), and impaired self-reference)]TJ -8.829 -1.398 TD 0 Tc 0 Tw (\()Tj /TT7 1 Tf 0.309 0 TD (p)Tj /TT2 1 Tf 0.477 0 TD -0.0231 Tc -0.0625 Tw [( < .0001\).)]TJ 14 0 0 14 321 200.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 200.64 Tm 0.002 Tc 0.125 Tw (Post hoc comparisons revealed that a self-sacrificing)Tj 0 -1.398 TD -0.0031 Tc 0.1042 Tw (defense style was associated with significantly higher)Tj 0 -1.401 TD -0.0033 Tc -0.0375 Tw (scores on all five of the TSI subscales, than the adaptive)Tj T* -0.0013 Tc 0.125 Tw (defense style.)Tj 14 0 0 14 321 142.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 142.65 Tm -0.0088 Tc -0.062 Tw (The maladaptive/image-distorting defense style was also)Tj T* -0.0033 Tc 0.095 Tw (associated with significantly higher scores on the TSI)Tj 0 -1.398 TD -0.0037 Tc 0.093 Tw (impaired self-reference and dissociation subscale than)Tj 0 -1.401 TD -0.0033 Tc 0.0509 Tw [(the adaptive style. In addition, the maladaptive/image-)]TJ ET endstream endobj 302 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 304 0 obj << /Length 9890 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.1229 Tw [(72 )]TJ /TT3 1 Tf 2.295 0 TD -0.0057 Tc 0.125 Tw (Selected Annotated Journal Resources)Tj /TT2 1 Tf 10 0 0 10 72 722.64 Tm -0.0023 Tc (distorting style was also associated with significantly)Tj 0 -1.398 TD -0.0035 Tc -0.0081 Tw (higher scores on the dissociation subscale than the self-)Tj 0 -1.401 TD -0.0029 Tc 0.03 Tw (sacrificing defense style.)Tj 14 0 0 14 54 678.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 678.66 Tm 0.0012 Tc 0.125 Tw (The interaction of defense style and personal trauma)Tj T* -0.0036 Tc 0.048 Tw (was significant for intrusive experience \()Tj /TT7 1 Tf 16.449 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0032 Tc 0.05 Tw [( = .001\) and)]TJ -16.944 -1.401 TD -0.0039 Tc -0.0325 Tw (defensive avoidance \()Tj /TT7 1 Tf 8.574 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0026 Tc -0.035 Tw [( = .002\).)]TJ 14 0 0 14 54 634.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 634.65 Tm -0.004 Tc -0.044 Tw [(Another MANOV)128(A)58.2( resulted in a main ef)14(fect for defense)]TJ 0 -1.401 TD -0.0084 Tc -0.06 Tw (style \()Tj /TT7 1 Tf 2.349 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.492 0 TD -0.0115 Tc -0.0625 Tw [( = .028\), and experience working with trauma sur-)]TJ -2.841 -1.398 TD -0.0041 Tc 0.015 Tw (vivors \()Tj /TT7 1 Tf 3.069 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0033 Tc 0.0178 Tw [( = .007\), and a significant interaction between)]TJ -3.564 -1.401 TD -0.0161 Tc -0.0625 Tw (these variables \()Tj /TT7 1 Tf 6.099 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.486 0 TD -0.0162 Tc -0.0625 Tw [( = 0.28\).Follow up univariate tests found)]TJ -6.585 -1.401 TD -0.0036 Tc 0.098 Tw (significant findings for defensive avoidance, dissocia-)Tj 0 -1.398 TD -0.0042 Tc -0.0617 Tw (tion, and impaired self-reference.)Tj 14 0 0 14 54 548.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 548.64 Tm -0.0092 Tc -0.0618 Tw [(Follow up )51.1(ANOV)125.8(As for experience working with trauma)]TJ T* -0.0035 Tc -0.0092 Tw (patients was significant for impaired self reference \()Tj /TT7 1 Tf 20.604 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.013 Tc ( =)Tj -21.099 -1.401 TD -0.0036 Tc 0.115 Tw (.004\). It was found that participants who had worked)Tj T* -0.0098 Tc -0.0625 Tw (with trauma patients for two or fewer semesters endorsed)Tj 0 -1.398 TD -0.008 Tc -0.0621 Tw [(higher levels of trauma symptoms. However)31(, the interac-)]TJ 0 -1.401 TD -0.003 Tc 0.0913 Tw (tion of defense style and experience was only signifi-)Tj T* -0.0035 Tc -0.0367 Tw (cant for dissociation \()Tj /TT7 1 Tf 8.505 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0027 Tc -0.0375 Tw [( = .010\).)]TJ 14 0 0 14 54 448.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 448.65 Tm -0.0093 Tc -0.0619 Tw [(Another MANOV)125.7(A)58.9( revealed a significant main ef)14.7(fect for)]TJ 0 -1.401 TD -0.0197 Tc -0.06 Tw (defense style \()Tj /TT7 1 Tf 5.364 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.477 0 TD -0.0207 Tc -0.0629 Tw [( < .00 01\) and formal trauma-specific train-)]TJ -5.841 -1.398 TD -0.0063 Tc -0.0617 Tw (ing or coursework \()Tj /TT7 1 Tf 7.554 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0061 Tc -0.0621 Tw [( < .0001\) but the interaction was not)]TJ -8.049 -1.401 TD 0.0013 Tc 0.125 Tw (significant. Follow up univariate tests showed trends)Tj T* -0.0037 Tc 0.0275 Tw (toward significance for dissociation \()Tj /TT7 1 Tf 14.859 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0032 Tc 0.0287 Tw [( = .035\) and im-)]TJ -15.354 -1.398 TD -0.0078 Tc -0.0625 Tw (paired self-reference \()Tj /TT7 1 Tf 8.526 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.489 0 TD -0.0077 Tc -0.0625 Tw [( = .021\).)]TJ 14 0 0 14 54 362.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 362.64 Tm -0.0031 Tc -0.0452 Tw [(Finally)62.9(, using medium ef)17.9(fect sizes, exploratory post hoc)]TJ 0 -1.398 TD 0.0471 Tc 0.125 Tw (comparisons were conducted on trauma-specific)Tj 0 -1.401 TD -0.0058 Tc -0.0625 Tw (coursework and trauma symptoms. The results indicated)Tj T* -0.0035 Tc 0.0028 Tw (that participants with substantial training in trauma had)Tj 0 -1.398 TD -0.0192 Tw (lower levels of dissociation and impaired self-reference)Tj 0 -1.401 TD -0.0076 Tc -0.0622 Tw (than those with minimal training, and had lower levels of)Tj T* -0.0035 Tc -0.0217 Tw (impaired self-reference to those with no training.)Tj /TT1 1 Tf 11 0 0 11 54 246.66 Tm 0.0217 Tc 0 Tw [(CONCLUSIONS/SUMMAR)32.6(Y)]TJ /TT2 1 Tf 14 0 0 14 54 230.64 Tm 0 Tc ()Tj 10 0 0 10 72 230.64 Tm -0.003 Tc 0.0225 Tw (This study finds support for the hypotheses that vicari-)Tj 0 -1.398 TD -0.0034 Tc 0.03 Tw (ous trauma may be linked to the amount and degree of)Tj 0 -1.401 TD -0.0037 Tc -0.023 Tw (trauma-specific coursework, a trainees previous experi-)Tj T* -0.0035 Tc 0.1186 Tw [(ence working with trauma clients, and a trainee)50.5(s de-)]TJ 0 -1.398 TD -0.0021 Tc 0.1 Tw (fense style.)Tj 14 0 0 14 54 158.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 158.64 Tm -0.0007 Tc 0.125 Tw [(Specifically)59.3(, these finding suggest that trauma symp-)]TJ T* -0.0066 Tc -0.0625 Tw (toms for participants with an adaptive defense style were)Tj 0 -1.401 TD -0.0033 Tc 0.1029 Tw (relatively the same regardless of personal trauma his-)Tj T* 0.0011 Tc 0 Tw [(tory)64.1(.)]TJ 14 0 0 14 54 100.65 Tm 0 Tc ()Tj 10 0 0 10 72 100.65 Tm -0.0036 Tc 0.0908 Tw (Participants who engaged in a self-sacrificing defense)Tj T* -0.0118 Tc -0.0622 Tw (style and reported a history of personal trauma had higher)Tj 0 -1.398 TD -0.0032 Tc 0.125 Tw (levels of trauma symptoms than participants with the)Tj 25.5 64.998 TD -0.0029 Tc 0.0107 Tw (same defense style without a history of trauma.)Tj 14 0 0 14 309 706.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 706.65 Tm -0.0034 Tc -0.0493 Tw [(Conversely)59.6(, participants who could be classified as hav-)]TJ 0 -1.401 TD -0.01 Tc -0.0625 Tw (ing a maladaptive/image-distorting defense style and had)Tj 0 -1.398 TD -0.0033 Tc 0.1 Tw (a history of personal trauma endorsed lower levels of)Tj 0 -1.401 TD -0.0102 Tc -0.0625 Tw (trauma symptoms than the participants who had the same)Tj T* 0.0041 Tc 0.125 Tw (defense style but had no history of personal trauma.)Tj 0 -1.398 TD -0.0036 Tc 0.0153 Tw [(However)35.4(, due to a small cell size these findings should)]TJ 0 -1.401 TD 0.0167 Tw (be interpreted with caution.)Tj /TT1 1 Tf 11 0 0 11 309 590.64 Tm 0.0255 Tc 0 Tw [(CONTRIBUTIONS/IMPLICA)63.7(TIONS)]TJ /TT2 1 Tf 14 0 0 14 309 574.65 Tm 0 Tc ()Tj 10 0 0 10 327 574.65 Tm -0.0033 Tc 0.0106 Tw (The findings of this survey could have implications for)Tj T* -0.0037 Tc 0.0533 Tw (graduate school training programs. For example, these)Tj 0 -1.398 TD -0.0035 Tc 0.0421 Tw (results indicate that when trainees have previous train-)Tj 0 -1.401 TD -0.0095 Tc -0.0622 Tw (ing in trauma specific work, more than a one-time lecture)Tj T* -0.0023 Tc 0.125 Tw [(or class discussion, they are less likely to experience)]TJ 0 -1.398 TD -0.0152 Tc -0.0625 Tw (vicarious trauma. Thus it is imperative that graduate train-)Tj 0 -1.401 TD -0.0104 Tc -0.0622 Tw (ing programs include both didactic and experiential work)Tj T* -0.0037 Tc -0.06 Tw (with trauma clients.)Tj 14 0 0 14 309 460.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 460.65 Tm 0.0066 Tc 0.125 Tw [(Based on the results of their study)63.6(, the authors sug-)]TJ T* -0.0035 Tc 0.095 Tw (gested that supervisors may want to conduct informal)Tj 0 -1.398 TD -0.0032 Tc 0.0381 Tw (assessments of trainees defense style in order to iden-)Tj 0 -1.401 TD -0.0029 Tc 0.0137 Tw [(tify each trainee)54.1(s specific needs.)]TJ 14 0 0 14 309 402.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 402.66 Tm -0.0027 Tc 0.125 Tw [(As a result of this study)63.3(, it seems that supervisors of)]TJ T* -0.0035 Tc -0.035 Tw (trainees working with trauma clients need to be alert for)Tj T* -0.0029 Tc -0.0084 Tw (symptoms of vicarious trauma \(especially identify con-)Tj 0 -1.398 TD -0.0035 Tc 0.052 Tw (fusion and disruptions in self concept\).)Tj 14 0 0 14 309 344.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 344.64 Tm -0.0013 Tc 0.125 Tw (When working with student trainees encouraging de-)Tj T* -0.005 Tc -0.0621 Tw [(fenses such as sublimation, humor)34(, and suppression may)]TJ 0 -1.401 TD -0.0222 Tc (help decrease the chance of experiencing vicarious trauma.)Tj T* -0.0035 Tc -0.0265 Tw (On the other hand, trainees who engage in a less mature)Tj 0 -1.398 TD -0.0042 Tc -0.0622 Tw (defense style may need to be more closely monitored for)Tj 0 -1.401 TD -0.0035 Tc -0.0216 Tw (symptoms of vicarious trauma.)Tj 14 0 0 14 309 258.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 258.66 Tm -0.0032 Tc 0.0218 Tw [(Finally)62.8(,)0.1( the authors indicate that having a personal his-)]TJ T* -0.0036 Tc -0.0625 Tw (tory of trauma and engaging in a self-sacrificing defense)Tj T* -0.0034 Tc -0.0622 Tw (style can put trainees at risk for vicarious trauma. There-)Tj 0 -1.398 TD 0.0008 Tc 0.125 Tw (fore, the authors assert that supervisors must be pre-)Tj 0 -1.401 TD -0.0036 Tc -0.0288 Tw (pared to talk about the potential impact of working with)Tj T* -0.0108 Tc -0.0625 Tw (trauma patients with trainees who have a personal trauma)Tj 0 -1.398 TD -0.0072 Tc -0.0623 Tw [(history)61.8(, while being mindful of a trainees right to privacy)]TJ ET 3.99 w /GS1 gs 309 150.015 m 546 150.015 l S BT /TT1 1 Tf 11 0 0 11 309 131.01 Tm /GS2 gs 0.0139 Tc 0.125 Tw [(W)59.4(eierich, M.R. & Nock, M.K. \(2008\). Posttrau-)]TJ 0 -1.1836 TD 0.0178 Tc (matic stress symptoms mediate the relation be-)Tj 0 -1.1809 TD -0.0034 Tc 0.0712 Tw (tween childhood sexual abuse and nonsuicidal self)Tj T* -0.0036 Tc 0 Tw [(injury)54.6(.)-3.6( )]TJ /TT6 1 Tf 3.1364 0 TD -0.0034 Tc 0.0482 Tw (Journal of Consulting and Clinical Psychol-)Tj ET 0.99 w /GS1 gs 309 70.515 m 546 70.515 l S BT 11 0 0 11 309 78.99 Tm /GS2 gs 0.0127 Tc 0.1273 Tw [(o)5.1(g)5.1(y)34.5(, 76,)]TJ /TT1 1 Tf 3.3764 0 TD 0.0121 Tc [( 39-44.)]TJ ET endstream endobj 305 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 307 0 obj << /Length 9685 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (73)Tj /TT1 1 Tf 11 0 0 11 66 722.64 Tm -0.008 Tc 0.1236 Tw [(TYPE OF)27.5( )46.5(A)10(R)27.5(TICLE)]TJ /TT2 1 Tf 14 0 0 14 66 706.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 706.65 Tm -0.0038 Tc 0.0413 Tw (Original empirical investigation: Passive observational)Tj 0 -1.401 TD 0.0178 Tc 0 Tw (design)Tj /TT1 1 Tf 11 0 0 11 66 660.66 Tm 0.0059 Tc 0.1263 Tw [(OBJECTIVES/PURPOSE OF)33.2( )14(THE )47.4(A)10.2(R)27.7(TICLE)]TJ /TT2 1 Tf 14 0 0 14 66 644.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 644.64 Tm -0.0032 Tc 0.1039 Tw (The purpose of this study was to investigate the rela-)Tj 0 -1.398 TD -0.0034 Tc -0.0083 Tw (tionship between nonsuicidal self-injury \(NNSI\), or the)Tj 0 -1.401 TD 0.0532 Tw (direct and deliberate destruction of body tissue in the)Tj T* -0.002 Tc 0.125 Tw (absence of suicidal intent, \(p. 39\) and posttraumatic)Tj 0 -1.398 TD -0.0034 Tc -0.0169 Tw (stress disorder \(PTSD\) symptoms for clients with a his-)Tj 0 -1.401 TD -0.002 Tc 0.1249 Tw [(tory of childhood abuse. 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be significantly associated with NSSI \()]TJ /TT7 1 Tf 18.834 0 TD -0.006 Tc 0 Tw (p )Tj /TT2 1 Tf 0.717 0 TD -0.0036 Tc -0.03 Tw (< .01\))Tj -19.551 -1.401 TD -0.002 Tc 0.125 Tw (when controlling for the presence of BPD and MDD)Tj T* -0.0034 Tc -0.0107 Tw (symptoms. In addition, MDD, PTSD, and symptoms of)Tj 0 -1.398 TD -0.004 Tc -0.061 Tw (reexperiencing and avoidance/numbing were also found)Tj 0 -1.401 TD -0.0027 Tc 0.025 Tw (to be significantly \()Tj /TT7 1 Tf 7.824 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0034 Tc 0.0267 Tw [( < .05\) associated with NSSI after)]TJ -8.319 -1.401 TD -0.0037 Tc -0.028 Tw (controlling for BPD and sexual abuse.)Tj 14 0 0 14 54 142.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 142.65 Tm -0.0035 Tc -0.009 Tw (Using separate regression analyses both reexperiencing)Tj T* 0.0046 Tc 0.125 Tw (and avoidance/numbing symptoms were found to be)Tj 0 -1.398 TD -0.0034 Tc -0.0581 Tw (mediators in the relation between the frequency of NSSI)Tj 0 -1.401 TD -0.0038 Tc 0.05 Tw (and childhood sexual abuse.)Tj /TT1 1 Tf 11 0 0 11 309 722.64 Tm 0.0217 Tc 0 Tw [(CONCLUSIONS/SUMMAR)32.6(Y)]TJ /TT2 1 Tf 14 0 0 14 309 706.65 Tm 0 Tc ()Tj 10 0 0 10 327 706.65 Tm -0.0033 Tc 0.0312 Tw (Results of this study indicate that in adolescence NSSI)Tj T* 0.0062 Tc 0.125 Tw (is associated with retrospective reports of childhood)Tj 0 -1.398 TD -0.0036 Tc (sexual abuse. The same was not found for nonsexual)Tj 0 -1.401 TD -0.015 Tw (abuse which includes incidents of physical and/or emo-)Tj T* -0.0037 Tc 0.09 Tw (tional abuse.)Tj 14 0 0 14 309 634.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 634.65 Tm -0.0037 Tc -0.0425 Tw (Since incidents of maltreatment often go underreported,)Tj T* -0.0036 Tc -0.0356 Tw (thus the authors contend that the trends discussed above)Tj 0 -1.398 TD -0.0029 Tc -0.029 Tw (may actually occur in greater magnitude.)Tj /TT1 1 Tf 11 0 0 11 309 574.65 Tm 0.0255 Tc 0 Tw [(CONTRIBUTIONS/IMPLICA)63.7(TIONS)]TJ /TT2 1 Tf 14 0 0 14 309 558.66 Tm 0 Tc ()Tj 10 0 0 10 327 558.66 Tm -0.0031 Tc -0.0115 Tw (Survivors of child sexual abuse are more likely to, or at)Tj 0 -1.401 TD -0.0037 Tc 0.0422 Tw [(risk for)38.3(, NSSI behavior in adolescence. )17.4(These findings)]TJ T* -0.0032 Tc 0.0305 Tw (should be taken into account in treatment and early in-)Tj 0 -1.398 TD -0.0034 Tc -0.0491 Tw (tervention planning to potentially reduce the occurrence)Tj 0 -1.401 TD -0.0201 Tc -0.06 Tw (of NSSI.)Tj 14 0 0 14 309 486.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 486.66 Tm -0.0034 Tc 0.0227 Tw (Since NSSI was found to be mediated by PTSD symp-)Tj T* -0.0038 Tc -0.015 Tw (toms such as reexperiencing and avoidance/numbing, it)Tj T* -0.003 Tc -0.0532 Tw (may be important to help clients relieve these secondary)Tj 0 -1.398 TD -0.0037 Tc -0.0138 Tw (symptoms without engaging in NSSI.)Tj 14 0 0 14 309 428.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 428.64 Tm -0.0036 Tc 0.02 Tw (The authors noted that given the small sample size and)Tj T* 0.0001 Tc 0.125 Tw (the use of cross-sectional data the generalizability of)Tj 0 -1.401 TD -0.005 Tc -0.0617 Tw (their findings is limited.)Tj 14 0 0 14 309 384.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 384.66 Tm -0.0029 Tc -0.0299 Tw [(Additionally)60.1(, they suggested that their findings may not)]TJ T* -0.0033 Tc 0.0687 Tw (apply to adolescents who conceal their NSSI, those in)Tj T* -0.0036 Tc -0.005 Tw (inpatient settings, and those who were unwilling to dis-)Tj 0 -1.398 TD -0.0031 Tc 0.0775 Tw [(cuss these topics in a research study)59.9(.)]TJ ET 3.99 w /GS1 gs 309 318.015 m 546 318.015 l S BT /TT1 1 Tf 11 0 0 11 309 299.01 Tm /GS2 gs 0.0206 Tc 0.125 Tw (Bryant, R.A., Sutherland, K., & Guthrie, R.M.)Tj 0 -1.1836 TD 0.0589 Tc 0.2322 Tw [(\(2007\). Impair)12.5(ed Specific )51.1(Autobiographical)]TJ 0 -1.1809 TD -0.0037 Tc 0.0483 Tw [(Memory as a Risk Factor)15.4( for)12.7( Posttraumatic S)42.7(t)1.3(r)12.7(ess)]TJ T* -0.0035 Tc -0.0256 Tw [(after)12.9( T)77.1(rauma. )]TJ /TT6 1 Tf 6.1364 0 TD -0.0037 Tc -0.0085 Tw [(Journal of )35.1(Abnormal Psychology)31.8(, 1)50.9(1)6.3(6)]TJ ET 0.99 w /GS1 gs 309 238.515 m 546 238.515 l S BT /TT1 1 Tf 11 0 0 11 309 246.99 Tm /GS2 gs 0.0179 Tc 0 Tw (\(4)Tj /TT6 1 Tf 0.8782 0 TD 0.0271 Tc (\), )Tj /TT1 1 Tf 1.0391 0 TD 0.0227 Tc (837-841.)Tj -1.9173 -3.1227 TD -0.008 Tc 0.1236 Tw [(TYPE OF)27.5( )46.5(A)10(R)27.4(TICLE)]TJ /TT2 1 Tf 14 0 0 14 309 196.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 196.65 Tm -0.0089 Tc -0.0625 Tw (Original empirical investigation)Tj /TT1 1 Tf 11 0 0 11 309 164.64 Tm 0.0059 Tc 0.1263 Tw [(OBJECTIVES/PURPOSE OF)33.2( )14(THE )47.4(A)10.2(R)27.7(TICLE)]TJ /TT2 1 Tf 14 0 0 14 309 148.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 148.65 Tm 0.0308 Tc 0.125 Tw (The present study addressed the issue of whether)Tj 0 -1.401 TD -0.0089 Tc -0.0624 Tw [(overgeneral autobiographical memory retrieval is a )]TJ /TT7 1 Tf 19.89 0 TD -0.0112 Tc 0 Tw (func-)Tj -19.89 -1.398 TD -0.0039 Tc (tion )Tj /TT2 1 Tf 1.86 0 TD -0.0037 Tc 0.0742 Tw (of posttraumatic stress and depression or whether)Tj -1.86 -1.401 TD -0.003 Tc 0.0875 Tw (it serves as a )Tj /TT7 1 Tf 5.64 0 TD -0.0039 Tc 0.09 Tw (vulnerability factor)Tj /TT2 1 Tf 7.764 0 TD 0.0884 Tw [( for the development)]TJ -13.404 -1.401 TD -0.0035 Tc 0.0017 Tw (of posttraumatic stress symptoms following a trauma.)Tj ET endstream endobj 311 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 313 0 obj << /Length 8877 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (75)Tj /TT2 1 Tf 14 0 0 14 66 721.65 Tm 0 Tc ()Tj 10 0 0 10 84 721.65 Tm -0.0035 Tc 0.0883 Tw (Past findings have indicated that overgeneral memory)Tj 0 -1.401 TD 0.0744 Tw (retrieval is associated with poor coping in response to)Tj 0 -1.398 TD 0.0579 Tw (traumatic events due to difficulties in problem solving)Tj 0 -1.401 TD -0.0045 Tc -0.0625 Tw (and utilizing past experiences to prepare for future expe-)Tj T* -0.0032 Tc 0.0925 Tw (riences. Thus, this study was designed to assess auto-)Tj 0 -1.398 TD 0.0214 Tc 0.125 Tw (biographical memory retrieval prior to a traumatic)Tj 0 -1.401 TD 0.0358 Tc (experience and measure the relationship between)Tj T* -0.0039 Tc -0.0625 Tw (overgeneral retrieval and future posttraumatic stress and)Tj 0 -1.398 TD -0.0017 Tc 0.125 Tw (depressive symptoms.)Tj 14 0 0 14 66 593.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 593.64 Tm -0.0033 Tc 0.0425 Tw (It was hypothesized that preexisting \(pre-trauma\) defi-)Tj T* -0.0036 Tc 0.0267 Tw (cits in retrieval for specific autobiographical memories)Tj 0 -1.401 TD -0.0044 Tc -0.0622 Tw (or elevated categoric memories would predict the occur-)Tj T* 0.0259 Tc 0.1249 Tw (rence of posttraumatic stress and depression post-)Tj 0 -1.398 TD -0.0169 Tc 0 Tw (trauma.)Tj /TT1 1 Tf 11 0 0 11 66 505.65 Tm 0.0434 Tc (METHOD)Tj 0 -1.4536 TD 0.0026 Tc (Participants)Tj /TT2 1 Tf 14 0 0 14 66 473.64 Tm 0 Tc ()Tj 10 0 0 10 84 473.64 Tm -0.0123 Tc -0.0621 Tw [(Sixty male recruits of the New South )14.8(W)94.5(ales Fire Brigades)]TJ 0 -1.398 TD 0.0338 Tc 0.125 Tw (were initially evaluated prior to beginning active)Tj 0 -1.401 TD -0.0128 Tc 0 Tw (firefighting.)Tj 14 0 0 14 66 429.66 Tm 0 Tc ()Tj 10 0 0 10 84 429.66 Tm -0.0045 Tc -0.0625 Tw (Forty-six \(77%\) of the original 60 firefighters were reas-)Tj T* -0.016 Tc (sessed approximately 4 years \(average of 49 months \()Tj /TT7 1 Tf 20.16 0 TD -0.0282 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.179 0 TD 0 Tc (=)Tj -21.339 -1.401 TD -0.0062 Tc -0.0625 Tw (1.59\)\) after the initial evaluation.)Tj 0.6 -1.599 TD -0.0046 Tc -0.0622 Tw [(o)-704.6(\(During those 4 years, all participants were exposed)]TJ 1.2 -1.401 TD -0.0036 Tc -0.04 Tw (to multiple traumatic events\).)Tj 14 0 0 14 66 355.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 355.65 Tm -0.003 Tc -0.05 Tw (Mean age was 29.6 years \()Tj /TT7 1 Tf 10.341 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.209 0 TD -0.0034 Tc -0.055 Tw (= 5.0\))Tj 14 0 0 14 66 339.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 339.66 Tm -0.0038 Tc -0.0114 Tw (Information on SES and race was not provided.)Tj 14 0 0 14 66 323.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 323.64 Tm 0.011 Tc 0.125 Tw (Reasons for non-participation: residential move \(1\),)Tj 0 -1.398 TD -0.0059 Tc -0.0622 Tw (physical injury- workers compensation \(1\), refused to be)Tj 0 -1.401 TD -0.0037 Tc 0.1 Tw (reassessed \(12\).)Tj /TT1 1 Tf 11 0 0 11 66 263.64 Tm 0.0242 Tc 0 Tw (Procedure)Tj /TT2 1 Tf 14 0 0 14 66 247.65 Tm 0 Tc ()Tj 10 0 0 10 84 247.65 Tm -0.0035 Tc 0.0028 Tw (Participants were evaluated for the presence of lifetime)Tj T* -0.0037 Tc 0.015 Tw [(and current )50.3(Axis I disorders using the S)17.3(tructured Clini-)]TJ 0 -1.398 TD -0.0214 Tc -0.0625 Tw (cal Interview for DSM-IV \(SCID-IV\).)Tj 14 0 0 14 66 203.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 203.64 Tm -0.0034 Tc -0.0132 Tw [(T)73.4(o)0( assess for exposure to prior traumatic events partici-)]TJ T* -0.0039 Tc 0.0453 Tw [(pants were evaluated using the Clinician )53.4(Administered)]TJ 0 -1.401 TD -0.004 Tc 0.0614 Tw (PTSD Scale \(CAPS\), and the Traumatic Events Ques-)Tj T* -0.0034 Tc 0.0808 Tw (tionnaire \(TEQ\). During the initial evaluation, partici-)Tj 0 -1.398 TD -0.0115 Tc -0.0622 Tw (pants were asked to respond to the CAPS interview based)Tj 0 -1.401 TD -0.0031 Tc 0.0442 Tw (on a very distressing event they had experienced.)Tj 14 0 0 14 66 117.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 117.66 Tm -0.0034 Tc 0.0971 Tw [(T)73.4(o)0( assess for depressive symptoms present within the)]TJ T* 0.0006 Tc 0.125 Tw (past two weeks, participants were assessed using the)Tj T* -0.005 Tc -0.0616 Tw (Beck Depression Inventory \(BDI-II\).)Tj 14 0 0 14 321 720.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 720.66 Tm 0.0004 Tc 0.125 Tw (Cue words \(5 positive and 5 negative\) were selected)Tj T* -0.0039 Tc -0.0625 Tw (from the 1,000 most frequently used English words. The)Tj T* 0.0583 Tw (positive words were )Tj /TT7 1 Tf 8.406 0 TD -0.0033 Tc 0.0606 Tw [(happy)53.7(, brave, safe, love, )]TJ /TT2 1 Tf 10.104 0 TD -0.0064 Tc 0 Tw (and)Tj /TT7 1 Tf 1.431 0 TD -0.0043 Tc 0.06 Tw [( spe-)]TJ -19.941 -1.398 TD -0.0048 Tc 0 Tw (cial)Tj /TT2 1 Tf 1.485 0 TD -0.0036 Tc 0.0306 Tw [(. )18(The negative words were )]TJ /TT7 1 Tf 11.151 0 TD -0.0033 Tc 0.0301 Tw [(hurt, tense, angry)56.5(,)0.1( fear)104.7(,)]TJ /TT2 1 Tf -12.636 -1.401 TD -0.0064 Tc 0 Tw (and)Tj /TT7 1 Tf 1.431 0 TD -0.0037 Tc -0.055 Tw [( stress)]TJ /TT2 1 Tf 2.448 0 TD -0.0034 Tc -0.06 Tw [(. The two practice words were )]TJ /TT7 1 Tf 12.087 0 TD -0.0046 Tc 0 Tw (egg )Tj /TT2 1 Tf 1.62 0 TD -0.0064 Tc (and)Tj /TT7 1 Tf 1.428 0 TD -0.0041 Tc -0.06 Tw [( choco-)]TJ -19.014 -1.401 TD -0.0048 Tc 0 Tw (late)Tj /TT2 1 Tf 1.485 0 TD -0.0033 Tc -0.0146 Tw [(. Each word was printed on a white card. The order)]TJ -1.485 -1.398 TD -0.0037 Tc -0.0014 Tw (of presentation was randomized, but positive and nega-)Tj 0 -1.401 TD -0.0036 Tc -0.0033 Tw (tive words were alternated.)Tj 14 0 0 14 321 606.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 606.66 Tm -0.0039 Tc -0.0621 Tw (While being audiotaped, participants were asked to state)Tj T* -0.0177 Tc -0.0625 Tw (the first specific personal memory triggered by each word.)Tj T* -0.0036 Tc 0.0792 Tw (The experimenter read the word while simultaneously)Tj 0 -1.398 TD -0.0329 Tw (showing the participant the printed word. If participants)Tj 0 -1.401 TD -0.0033 Tc -0.0143 Tw [(did not provide a specific memory)59.7(, they were prompted)]TJ T* -0.0035 Tc 0.115 Tw (with Can you think of a specific time-one particular)Tj 0 -1.398 TD -0.003 Tc 0.0368 Tw (event? If participants did not offer a specific memory)Tj 0 -1.401 TD -0.0036 Tc 0.0142 Tw (within 60 seconds, the experimenter presented the next)Tj T* -0.0138 Tc 0 Tw (word.)Tj 0.6 -1.599 TD 0.0058 Tc 0.125 Tw [(o)-694.2(Coding of audiotapes was conducted by a blind)]TJ 1.2 -1.401 TD -0.0088 Tc -0.0624 Tw [(rater)54.2(. Memories were coded as specific if they incor)18.2(-)]TJ 0 -1.398 TD -0.0034 Tc 0.0992 Tw (porated a particular event occurring on a specific)Tj 0 -1.401 TD -0.0089 Tc -0.0624 Tw [(day)66.1(. Coding occurred for: Specificity of the memory)]TJ T* -0.0031 Tc 0.1086 Tw (\(event that occurred on a specific day\), categoric)Tj 0 -1.398 TD -0.0037 Tc -0.015 Tw (memories \(a summary of memories\), and extended)Tj 0 -1.401 TD -0.0035 Tc 0.113 Tw [(memories \(events lasting longer than a day)62.5(.\) )14.6(The)]TJ T* -0.0032 Tc 0.0693 Tw (mean kappa coefficient of reliability was 0.87 for)Tj 0 -1.398 TD -0.0083 Tc -0.0625 Tw (specificity of memories.)Tj 14 0 0 14 321 350.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 350.64 Tm 0.0068 Tc 0.125 Tw [(Reassessments occurred on 3 occasions: a\) within 1)]TJ T* -0.0051 Tc -0.0623 Tw [(month of initial trauma after commencing active duty)60.9(, b\))]TJ 0 -1.401 TD -0.0031 Tc 0.0207 Tw [(6 months after commencing active duty)59.9(, and c\) 3 years)]TJ T* -0.0035 Tc -0.0616 Tw [(after commencing active firefighting duty)62.5(. Note: During)]TJ 0 -1.398 TD 0.0031 Tc 0.125 Tw (Time 1 some participants received the Posttraumatic)Tj 0 -1.401 TD -0.0059 Tc -0.0622 Tw (Cognitions Inventory \(PTCI\), but these data are reported)Tj T* -0.0031 Tc 0.0095 Tw (elsewhere - not in the current study due to a 40% over-)Tj 0 -1.398 TD -0.0035 Tc -0.0225 Tw (lap with the current sample.)Tj 14 0 0 14 321 236.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 236.64 Tm -0.0118 Tc -0.0625 Tw (Approximately 3 years after beginning active firefighting)Tj T* -0.0033 Tc 0.0212 Tw [(duty)62.7(, participants were mailed a package that informed)]TJ 0 -1.401 TD 0 Tw (them that the current survey was intended to index cur-)Tj T* -0.0023 Tc 0.125 Tw (rent coping levels within the fire brigade. They were)Tj 0 -1.398 TD 0.0003 Tc (asked to document the number and type of incidents)Tj 0 -1.401 TD (they had attended and whether they had been threat-)Tj T* -0.0036 Tc 0.1085 Tw (ened or witnessed others being threatened or harmed.)Tj 0 -1.398 TD -0.0034 Tc 0.02 Tw (They also completed the BDI-II, and the Posttraumatic)Tj 0 -1.401 TD -0.0062 Tc -0.0622 Tw (Diagnostic Scale \(PDS\), which assists in PTSD diagnos-)Tj T* -0.0031 Tc 0.0225 Tw (tic decisions and the determination of a severity score.)Tj ET endstream endobj 314 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 316 0 obj << /Length 10318 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.1229 Tw [(76 )]TJ /TT3 1 Tf 2.295 0 TD -0.0057 Tc 0.125 Tw (Selected Annotated Journal Resources)Tj /TT1 1 Tf 11 0 0 11 54 722.64 Tm 0.0154 Tc 0 Tw [(RESUL)83.6(TS)]TJ 0 -1.4536 TD 0.005 Tc 0.1273 Tw (Pretrauma Characteristics)Tj /TT2 1 Tf 14 0 0 14 54 690.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 690.66 Tm -0.0035 Tc 0.0119 Tw (At Time 1, participants experienced an average of 2.20)Tj 0 -1.401 TD 0 Tc 0 Tw (\()Tj /TT7 1 Tf 0.375 0 TD 0.0378 Tc (SD)Tj /TT2 1 Tf 1.311 0 TD 0.0447 Tc 0.125 Tw (=1.79\) traumatic events prior to becoming a)Tj -1.686 -1.401 TD -0.0183 Tc 0 Tw [(firefighter)50.7(.)]TJ 14 0 0 14 54 646.65 Tm 0 Tc ()Tj 10 0 0 10 72 646.65 Tm -0.0035 Tc -0.0227 Tw (Specific retrieval at Time 1 was not associated with ini-)Tj T* -0.0125 Tc -0.0613 Tw (tial scores on CAPS \()Tj /TT7 1 Tf 8.106 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.489 0 TD -0.0118 Tc -0.0625 Tw [( = 0\), BDI-II \()]TJ /TT7 1 Tf 5.274 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.492 0 TD -0.0113 Tc -0.063 Tw [( = .32\), or history of)]TJ -14.361 -1.398 TD -0.0038 Tc -0.05 Tw (traumatic events \()Tj /TT7 1 Tf 6.999 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0023 Tc -0.05 Tw [( = .29\).)]TJ 14 0 0 14 54 602.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 602.64 Tm -0.0012 Tc 0.125 Tw (Three participants reported a single major depressive)Tj 0 -1.398 TD -0.0036 Tc 0.0115 Tw [(episode and 1 participant reported prior panic disorder)50.4(.)]TJ 14 0 0 14 54 572.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 572.64 Tm -0.0035 Tc 0.0567 Tw [(No participants met criteria for an )50.5(Axis I disorder \(ac-)]TJ T* -0.0061 Tc -0.0625 Tw (cording to SCID\) or PTSD.)Tj 14 0 0 14 54 542.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 542.64 Tm -0.0031 Tc 0.1007 Tw (No participants reported any stress symptoms in rela-)Tj T* 0.043 Tw (tion to any previous traumatic events.)Tj 14 0 0 14 54 512.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 512.64 Tm -0.0048 Tc -0.0622 Tw (The mean CAPS score \(combining frequency and sever-)Tj T* -0.002 Tc 0.0317 Tw (ity\) was .04 \()Tj /TT7 1 Tf 5.346 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.209 0 TD -0.0032 Tc 0.0318 Tw [( = .21, range = 0-1\). The mean BDI-II)]TJ -6.555 -1.401 TD -0.0089 Tc -0.0616 Tw (score was 2.39 \()Tj /TT7 1 Tf 6.174 0 TD -0.0162 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.2 0 TD -0.0086 Tc -0.0625 Tw [( = 4.16; range: 0-16\).)]TJ /TT1 1 Tf 11 0 0 11 54 452.64 Tm 0.0149 Tc 0.1248 Tw [(Posttraumatic S)42.2(t)-4.6(r)17.6(ess and Depr)14.9(ession Levels)]TJ /TT2 1 Tf 14 0 0 14 54 436.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 436.65 Tm -0.0036 Tc -0.0106 Tw (Seven \(16%\) met criteria for PTSD at the follow-up as-)Tj 0 -1.401 TD -0.0038 Tc 0.0943 Tw (sessment. The mean PDS score was 4.87 \()Tj /TT7 1 Tf 17.43 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.209 0 TD -0.003 Tc 0.095 Tw [( = 8.67;)]TJ -18.639 -1.398 TD -0.0032 Tc 0.0518 Tw (range: 0-39\) indicating that the majority of the sample)Tj 0 -1.401 TD -0.018 Tc -0.0622 Tw (reported little posttraumatic stress. The mean BDI-II score)Tj T* -0.0136 Tc -0.0625 Tw (was 7.17 \()Tj /TT7 1 Tf 3.879 0 TD -0.0222 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.191 0 TD -0.0132 Tc -0.0625 Tw [( = 7.75; range: 0-34\).)]TJ /TT1 1 Tf 11 0 0 11 54 348.66 Tm 0.005 Tc 0.125 Tw (Autobiographical Memory Patterns)Tj /TT2 1 Tf 14 0 0 14 54 332.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 332.64 Tm -0.0033 Tc 0.0706 Tw (There were no differences in retrieval of specific, cat-)Tj 0 -1.398 TD -0.0037 Tc 0.0308 Tw (egoric, extended or omitted memories between partici-)Tj 0 -1.401 TD -0.0019 Tc 0.125 Tw (pants who took part in the follow-up assessment and)Tj T* -0.0037 Tc 0.0583 Tw (those who did not.)Tj 14 0 0 14 54 274.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 274.65 Tm -0.0037 Tc 0.0575 Tw (Positive cues: Specific Memories \(Mean = 3.85, SD =)Tj T* -0.0039 Tc 0.0217 Tw (1.28\); Categoric Memories \()Tj /TT7 1 Tf 11.349 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.825 0 TD -0.0022 Tc 0.0233 Tw [( = 0.93, )]TJ /TT7 1 Tf 3.366 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.209 0 TD -0.0031 Tc 0.0233 Tw [( = 1.17\); Ex-)]TJ -16.749 -1.398 TD -0.0043 Tc -0.045 Tw (tended Memories \()Tj /TT7 1 Tf 7.395 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.825 0 TD -0.0024 Tc -0.0483 Tw [( = 0.11, )]TJ /TT7 1 Tf 3.15 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.209 0 TD -0.0037 Tc -0.0475 Tw [( = 0.28\); and Omissions)]TJ -12.579 -1.401 TD 0 Tc 0 Tw (\()Tj /TT7 1 Tf 0.315 0 TD -0.024 Tc (M )Tj /TT2 1 Tf 0.984 0 TD -0.0183 Tc -0.0625 Tw (= 0.11, )Tj /TT7 1 Tf 2.796 0 TD -0.0282 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.179 0 TD -0.0182 Tc -0.0625 Tw [( = 0.18\).)]TJ 14 0 0 14 54 216.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 216.66 Tm -0.0125 Tc -0.0612 Tw (Negative cues: Specific Memories \()Tj /TT7 1 Tf 13.659 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.822 0 TD -0.011 Tc -0.0633 Tw [( = 4.07, )]TJ /TT7 1 Tf 3.024 0 TD -0.0222 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.191 0 TD -0.012 Tc -0.0625 Tw [( = 0.97\);)]TJ -18.696 -1.401 TD -0.0042 Tc 0.0625 Tw (Categoric Memories \()Tj /TT7 1 Tf 8.82 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.825 0 TD -0.0022 Tc 0.0633 Tw [( = 0.65, )]TJ /TT7 1 Tf 3.486 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.209 0 TD -0.0034 Tc 0.065 Tw [( = 0.93\), Extended)]TJ -14.34 -1.401 TD -0.0047 Tc 0.025 Tw (Memories \()Tj /TT7 1 Tf 4.62 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.825 0 TD -0.0025 Tc 0.025 Tw [( = 0.24, )]TJ /TT7 1 Tf 3.369 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.212 0 TD -0.0035 Tc 0.025 Tw [( = 0.42\); and Omissions \()]TJ /TT7 1 Tf 10.215 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.825 0 TD 0.02 Tc ( =)Tj -21.066 -1.398 TD -0.024 Tc (0.04, )Tj /TT7 1 Tf 2.049 0 TD -0.0312 Tc (SD)Tj /TT2 1 Tf 1.17 0 TD -0.0239 Tc -0.0625 Tw [( = 0.18\).)]TJ /TT1 1 Tf 11 0 0 11 54 142.65 Tm 0.0038 Tc 0.1262 Tw [(Pr)17.4(ediction of Posttraumatic S)42(t)3.4(r)12(ess)]TJ /TT2 1 Tf 14 0 0 14 54 126.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 126.66 Tm -0.0038 Tc 0.0817 Tw (Hierarchical regression was conducted to examine the)Tj 0 -1.401 TD 0.0081 Tc 0.125 Tw (pretrauma variables that predict posttraumatic stress)Tj T* -0.0037 Tc -0.05 Tw (\(PDS total score\).)Tj 14 0 0 14 54 82.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 82.65 Tm 0.0031 Tc 0.125 Tw (Operated under the premise that posttraumatic stress)Tj 25.5 63.999 TD -0.0184 Tc -0.0625 Tw (would be predicted by lifetime history of traumatic events,)Tj 0 -1.398 TD -0.0002 Tc 0.125 Tw (preexisting levels of posttraumatic stress and depres-)Tj 0 -1.401 TD -0.011 Tc -0.0625 Tw [(sion, and pretrauma deficits in autobiographical memory)58(.)]TJ 14 0 0 14 309 678.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 678.66 Tm -0.0086 Tc -0.0625 Tw (Entered the following variables in separate steps: a\) TEQ)Tj T* -0.0035 Tc 0.1081 Tw (total score, b\) pretrauma CAPS and BDI-II scores, c\))Tj T* -0.0364 Tw (pretrauma retrieval of specific memories to positive cue)Tj 0 -1.398 TD -0.0111 Tc -0.0624 Tw (words, and d\) pretrauma retrieval of specific memories to)Tj 0 -1.401 TD -0.0038 Tc 0.0625 Tw (negative cue words.)Tj 14 0 0 14 309 606.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 606.66 Tm -0.0166 Tc -0.0621 Tw (Pretrauma deficits in retrieving specific memories to posi-)Tj T* -0.0035 Tc 0.0717 Tw [(tive cues accounted for 22% of the variance. )50.5(After re-)]TJ T* 0.014 Tc 0.125 Tw (moving an outlier and repeating the regression, the)Tj 0 -1.398 TD 0.003 Tc (reanalysis found that pretrauma deficits in retrieving)Tj 0 -1.401 TD -0.0048 Tc -0.0625 Tw (specific memories to positive cues accounted for 19% of)Tj T* -0.0036 Tc 0.035 Tw (the variance.)Tj 14 0 0 14 309 520.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 520.65 Tm -0.0035 Tc 0.1083 Tw (Pretrauma retrieval of categoric, extended, or omitted)Tj T* -0.0033 Tc -0.0425 Tw [(memories did not significantly predict PTSD severity)59.7(.)]TJ /TT1 1 Tf 11 0 0 11 309 474.66 Tm 0.0074 Tc 0.1258 Tw (Prediction of Posttraumatic Depression)Tj /TT2 1 Tf 14 0 0 14 309 458.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 458.64 Tm -0.004 Tc -0.0625 Tw (Hierarchical regression was conducted to predict BDI-II)Tj 0 -1.398 TD -0.0018 Tc 0.125 Tw (scores at follow-up utilizing same variables as in the)Tj 0 -1.401 TD -0.0036 Tc 0.0733 Tw (prediction of posttraumatic stress.)Tj 14 0 0 14 309 414.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 414.66 Tm -0.004 Tc 0.0028 Tw (Pretrauma CAPS and BDI-II scores accounted for 13%)Tj T* -0.0035 Tc -0.0121 Tw [(of the variance even after removing the outlier)50.5(.)]TJ 14 0 0 14 309 384.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 384.66 Tm -0.0166 Tc -0.0621 Tw (Pretrauma deficits in retrieving specific memories to posi-)Tj T* -0.0034 Tc 0.0178 Tw (tive cues accounted for 8% of the variance.)Tj 14 0 0 14 309 354.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 354.66 Tm -0.0035 Tc 0.1083 Tw (Pretrauma retrieval of categoric, extended, or omitted)Tj T* -0.004 Tc -0.0625 Tw (memories did not significantly predict depression sever-)Tj T* -0.0133 Tc 0 Tw [(ity)64.7(.)]TJ /TT1 1 Tf 11 0 0 11 309 294.66 Tm 0.0136 Tc 0.0787 Tw [(CONCLUSIONS AND )-46.8(IMPLICA)62.7(TIONS)]TJ /TT2 1 Tf 14 0 0 14 309 278.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 278.64 Tm -0.0036 Tc -0.0191 Tw (Major finding: pre-trauma deficits in retrieving specific)Tj 0 -1.398 TD -0.0038 Tc 0.0358 Tw (memories were associated with levels of posttraumatic)Tj 0 -1.401 TD -0.0035 Tc 0.0363 Tw (stress after a trauma. This finding provides support for)Tj T* -0.0031 Tc 0.1029 Tw (the hypothesis that retrieval deficits for specific auto-)Tj 0 -1.398 TD -0.01 Tc -0.0622 Tw (biographical memories may be a risk factor for the devel-)Tj 0 -1.401 TD -0.0034 Tc 0.015 Tw [(opment of a psychological disorder)50.6(.)]TJ 0.6 -1.599 TD 0.1128 Tw [(o)-703.4(Successful response to a trauma may involve the)]TJ 1.2 -1.401 TD -0.0073 Tc -0.0621 Tw [(ability to retrieve positive memories from one)52.7(s past)]TJ T* -0.0033 Tc 0.04 Tw (in order to create a context for a traumatic experi-)Tj 0 -1.398 TD 0.0046 Tc 0 Tw (ence.)Tj -1.2 -1.602 TD 0.0027 Tc 0.125 Tw [(o)-697.3(An additional possibility is that individuals who)]TJ 1.2 -1.398 TD -0.0153 Tc -0.0625 Tw (have more difficulty retrieving specific memories for)Tj 0 -1.401 TD -0.015 Tc -0.0621 Tw (positive cues may have poorer problem solving abili-)Tj T* -0.0034 Tc 0.1106 Tw (ties which is associated with higher levels of de-)Tj 0 -1.398 TD -0.0017 Tc 0.125 Tw (pression post-trauma.)Tj ET endstream endobj 317 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 319 0 obj << /Length 8200 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (77)Tj /TT2 1 Tf 14 0 0 14 66 722.64 Tm 0 Tc ()Tj 10 0 0 10 84 722.64 Tm -0.0032 Tc 0.0656 Tw (This study provided insight into the potential risk fac-)Tj 0 -1.398 TD 0.0136 Tc 0.125 Tw (tors for the development of posttraumtic symptoms)Tj 0 -1.401 TD -0.0108 Tc -0.0625 Tw (among emergency personnel who are frequently exposed)Tj T* -0.0038 Tc -0.045 Tw (to trauma.)Tj 14 0 0 14 66 664.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 664.65 Tm -0.0035 Tc 0.1225 Tw (Future research should assess for factors such as his-)Tj T* -0.0026 Tc 0.11 Tw (tory of depression, intelligence, early family environ-)Tj 0 -1.398 TD -0.0094 Tc -0.0624 Tw [(ment, cognitive functioning, problem solving ability)59.6(, and)]TJ 0 -1.401 TD -0.0138 Tc 0 Tw (rumination.)Tj 14 0 0 14 66 606.66 Tm 0 Tc ()Tj 10 0 0 10 84 606.66 Tm -0.0035 Tc 0.0609 Tw (Acknowledging the difficulty in generalizing from the)Tj T* -0.0034 Tc 0.0225 Tw (firefighter population to other groups, it will be impor-)Tj T* 0.0268 Tc 0.1249 Tw [(tant to assess these factors in more representative)]TJ 0 -1.398 TD -0.0031 Tc 0 Tw (samples.)Tj ET 3.99 w /GS1 gs 66 539.985 m 303 539.985 l S BT /TT1 1 Tf 11 0 0 11 66 521.01 Tm /GS2 gs 0.0207 Tc 0.1252 Tw [(Ariga, M., Uehara, )15.1(T)79.5(., )15.1(T)93.1(akeuchi, K., Ishige, )34.2(Y)99.2(.)-2.9(,)]TJ 0 -1.1836 TD 0.0002 Tc 0.1253 Tw [(Nakano, R., & Mikuni, M. \(2008\). )13.8(T)78.1(rauma expo-)]TJ 0 -1.1809 TD 0.0122 Tc 0.125 Tw (sure and posttraumatic stress disorder in delin-)Tj T* 0.0165 Tc 0.1257 Tw (quent female adolescents. )Tj /TT6 1 Tf 11.9236 0 TD 0.0163 Tc 0.1258 Tw (Journal of Child Psy-)Tj ET 0.99 w /GS1 gs 66 460.485 m 303 460.485 l S BT 11 0 0 11 66 468.99 Tm /GS2 gs 0.0108 Tc 0.1273 Tw (chology 49)Tj /TT1 1 Tf 4.71 0 TD 0.0116 Tc 0 Tw (\(1\),)Tj /TT6 1 Tf 1.4618 0 TD 0.0121 Tc 0.1272 Tw [( 79-87.)]TJ /TT1 1 Tf -6.1718 -4.5764 TD -0.008 Tc 0.1236 Tw [(TYPE OF)27.5( )46.5(A)10(R)27.5(TICLE)]TJ /TT2 1 Tf 14 0 0 14 66 402.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 402.66 Tm -0.0089 Tc -0.0625 Tw (Original empirical investigation)Tj /TT1 1 Tf 11 0 0 11 66 370.65 Tm 0.0059 Tc 0.1263 Tw [(OBJECTIVES/PURPOSE OF)33.2( )14(THE )47.4(A)10.2(R)27.7(TICLE)]TJ /TT2 1 Tf 14 0 0 14 66 354.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 354.66 Tm -0.003 Tc 0.0086 Tw (The aims of the current study are to:)Tj 0.6 -1.602 TD -0.0037 Tc 0.0208 Tw [(o)-703.7(Describe the nature and extent of trauma exposure)]TJ 1.2 -1.398 TD -0.0039 Tc 0.0292 Tw (and PTSD among incarcerated female juvenile of-)Tj 0 -1.401 TD -0.0036 Tc 0.03 Tw (fenders in Japan.)Tj -1.2 -1.599 TD -0.0078 Tc -0.0625 Tw [(o)-707.8(Clarify the point prevalence of PTSD in this popula-)]TJ 1.2 -1.401 TD -0.0014 Tc 0 Tw (tion.)Tj -1.2 -1.599 TD 0.0322 Tc 0.125 Tw [(o)-667.8(Examine the relationship between psychiatric)]TJ 1.2 -1.401 TD -0.0051 Tc -0.0625 Tw (comorbidity and PTSD.)Tj -1.2 -1.599 TD -0.0037 Tc 0.0358 Tw [(o)-703.7(Examine the associations between PTSD and psy-)]TJ 1.2 -1.401 TD -0.0034 Tc 0.0216 Tw (chosocial factors such as symptoms of depression,)Tj T* 0.0563 Tc 0.1248 Tw [(impulsivity)65.3(, abnormal eating behaviors and)]TJ 0 -1.398 TD 0.0005 Tc 0.125 Tw (parenting attitudes.)Tj -1.2 -1.602 TD -0.0034 Tc 0.0556 Tw [(o)-703.4(Determine the risk factors that can predict the de-)]TJ 1.2 -1.398 TD -0.0139 Tc -0.0622 Tw (velopment of PTSD and to determine whether symp-)Tj 0 -1.401 TD -0.0033 Tc 0.0313 Tw (toms correlate with psychosocial factors.)Tj -1.2 -1.599 TD -0.0129 Tw [(o)-703.3(Clarify factors related to PTSD evaluations in ado-)]TJ 1.2 -1.401 TD -0.0037 Tc 0.0475 Tw (lescent female offenders who have never received)Tj T* -0.0032 Tc -0.0117 Tw (psychiatric medication in Japan.)Tj /TT1 1 Tf 11 0 0 11 321 722.64 Tm 0.0344 Tc 0 Tw (METHODS)Tj 0 -1.4536 TD 0.0026 Tc (Participants)Tj /TT2 1 Tf 14 0 0 14 321 690.66 Tm 0 Tc ()Tj 10 0 0 10 339 690.66 Tm -0.0033 Tc 0.0791 Tw (Sixty-four female juvenile offenders \(recruited from a)Tj 0 -1.401 TD -0.0037 Tc -0.0375 Tw (group of 181 incarcerated adolescents- excluding: those)Tj T* 0.0143 Tw (who had received neuroleptics \(9% excluded\), or those)Tj 0 -1.398 TD -0.0029 Tc 0.125 Tw [(in a severe physical of psychiatric condition \(0% ex-)]TJ 0 -1.401 TD -0.0027 Tc 0.0306 Tw (cluded\). Only those with a psychiatric history were in-)Tj T* 0.0118 Tc 0.125 Tw (cluded. Sixty-four participants completed the initial)Tj 0 -1.398 TD -0.0037 Tc -0.0333 Tw (screening interview and questionnaires, but two refused)Tj 0 -1.401 TD -0.0002 Tc 0.125 Tw (to participate in the succeeding comprehensive inter-)Tj T* -0.0279 Tc 0 Tw [(view)56.1(.)]TJ 14 0 0 14 321 562.65 Tm 0 Tc ()Tj 10 0 0 10 339 562.65 Tm -0.0031 Tc -0.06 Tw (Ages ranged from 16 to 19 years \()Tj /TT7 1 Tf 13.17 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.825 0 TD -0.0025 Tc -0.06 Tw [( = 17.2, )]TJ /TT7 1 Tf 3.114 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.212 0 TD -0.0026 Tc -0.0625 Tw [( = 1.0\).)]TJ 14 0 0 14 321 546.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 546.66 Tm -0.0032 Tc 0.002 Tw (Ethnicity of all participants was Japanese.)Tj 14 0 0 14 321 530.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 530.64 Tm -0.0035 Tc -0.0188 Tw (Prior to incarceration, 55% of offenders were not living)Tj 0 -1.398 TD -0.0174 Tc -0.0617 Tw [(with their immediate family)60.6(.)]TJ 14 0 0 14 321 500.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 500.64 Tm -0.0033 Tc 0.0893 Tw (Sixty-one had dropped out of school before grade 10,)Tj T* -0.0037 Tc 0.0534 Tw (33% had not been admitted to high school. The others)Tj 0 -1.401 TD -0.0032 Tc -0.015 Tw (were currently enrolled in high school.)Tj 14 0 0 14 321 456.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 456.66 Tm -0.0074 Tc -0.0625 Tw (Forty-one percent were detained for drug-related crimes,)Tj T* -0.0115 Tc -0.0622 Tw [(30% for violent crimes, 22% for pre-delinquent behavior)51.5(.)]TJ T* -0.0037 Tc -0.0118 Tw (10% were multiple offenders, 60% had been arrested at)Tj 0 -1.398 TD -0.0035 Tc -0.035 Tw (least twice.)Tj /TT1 1 Tf 11 0 0 11 321 382.65 Tm 0.0313 Tc 0 Tw (Procedures)Tj /TT2 1 Tf 14 0 0 14 321 366.66 Tm 0 Tc ()Tj 10 0 0 10 339 366.66 Tm -0.0036 Tc -0.0494 Tw (Investigation was conducted as part of the regular medi-)Tj 0 -1.401 TD -0.0012 Tw (cal service for maintaining the mental health of offend-)Tj T* -0.003 Tc 0.0033 Tw (ers in reformatory schools.)Tj 14 0 0 14 321 322.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 322.65 Tm -0.0036 Tc -0.0293 Tw [(W)55.2(ritten informed consent was obtained from all partici-)]TJ T* -0.0034 Tc -0.0228 Tw (pants and the institutional head and chief director of the)Tj 0 -1.398 TD -0.0033 Tc 0.0812 Tw [(correction center approved the study)59.7(.)]TJ 14 0 0 14 321 278.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 278.64 Tm -0.0037 Tc 0.0579 Tw (The participants were provided with an explanation of)Tj T* -0.0005 Tc 0.125 Tw (the nature of the study and an information sheet and)Tj 0 -1.401 TD -0.003 Tc 0.0133 Tw (consent form. They were aware that the study was vol-)Tj T* -0.0026 Tc 0.0075 Tw (untary and that they could withdraw at any time.)Tj 14 0 0 14 321 220.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 220.65 Tm -0.0038 Tc 0.1225 Tw (During assessment, the interviewers were unaware of)Tj T* 0.1239 Tw [(the participant)50.1(s of)17.1(fense and background information.)]TJ 0 -1.398 TD -0.0032 Tc 0.0889 Tw [(W)55.6(ithin one week of the interview)59.8(, they were asked to)]TJ 0 -1.401 TD -0.0036 Tc 0.005 Tw (complete five self-rating questionnaires.)Tj /TT1 1 Tf 11 0 0 11 321 146.64 Tm 0.0557 Tc 0 Tw (Measures)Tj /TT2 1 Tf 14 0 0 14 321 130.65 Tm 0 Tc ()Tj 10 0 0 10 339 130.65 Tm -0.0179 Tc -0.0621 Tw (General: demographics, history of illegal drug use, trauma)Tj T* -0.0145 Tc -0.0626 Tw [(exposure history \(Clinician )48.4(Administered PTSD Scale for)]TJ 0 -1.398 TD -0.004 Tc 0.0084 Tw [(DSM-IV)86(- CAPS\), age, criminal )]TJ 12.7748 0 TD -0.0035 Tc 0.0074 Tw [(history)59.5(, recidivism his-)]TJ -12.7748 -1.401 TD -0.0028 Tc 0.0128 Tw [(tory)63.2(, family composition, living conditions, psychiatric)]TJ ET endstream endobj 320 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 323 0 obj << /Length 9181 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.1229 Tw [(78 )]TJ /TT3 1 Tf 2.295 0 TD -0.0057 Tc 0.125 Tw (Selected Annotated Journal Resources)Tj /TT2 1 Tf 10 0 0 10 72 722.64 Tm -0.0032 Tc -0.0545 Tw [(history)62.8(, familial alcohol and drug use, education, and IQ)]TJ 0 -1.398 TD -0.0033 Tc 0 Tw (\(previously measured\).)Tj /TT1 1 Tf 11 0 0 11 54 676.65 Tm 0.01 Tc 0.1274 Tw [(S)48(tructur)15.5(ed Interviews:)]TJ /TT2 1 Tf 14 0 0 14 54 660.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 660.66 Tm -0.001 Tc 0.1249 Tw [(Psychiatric Diagnosis- Japanese )13.9(V)112.2(ersion of the Mini-)]TJ 0 -1.401 TD -0.0174 Tc -0.062 Tw (International Neuropsychiatric Interview for Children and)Tj T* -0.0042 Tc -0.025 Tw (Adolescents \(MINI-kid\).)Tj 14 0 0 14 54 616.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 616.65 Tm -0.0035 Tc -0.0157 Tw (CAPS- for diagnosis and severity rating of PTSD.)Tj /TT1 1 Tf 11 0 0 11 54 584.64 Tm 0.0138 Tc 0.1273 Tw (Self-Rating Questionnaires)Tj /TT2 1 Tf 14 0 0 14 54 568.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 568.65 Tm -0.0154 Tc -0.0625 Tw (Japanese version of the DSM Scale for Depression \(DSD\))Tj T* -0.0036 Tc 0.065 Tw (for the diagnosis of depression.)Tj 14 0 0 14 54 538.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 538.65 Tm -0.0037 Tc -0.0457 Tw (Japanese version of the Barratt Impulsiveness Scale 11)Tj 5.8 0 0 5.8 286.5 542.01 Tm -0.002 Tc 0 Tw (th)Tj 10 0 0 10 72 524.64 Tm 0.0031 Tc 0.125 Tw (version \(BIS-11\) - provides and impulsiveness score)Tj 0 -1.398 TD -0.0035 Tc -0.0575 Tw [(based on motor impulsivity)62.5(, planning, and inappropriate)]TJ 0 -1.401 TD 0.0084 Tc 0 Tw (attention.)Tj 14 0 0 14 54 480.66 Tm 0 Tc ()Tj 10 0 0 10 72 480.66 Tm -0.0145 Tc -0.062 Tw [(Eating )48.7(Attitudes )15.7(T)71.3(est- 26 \(EA)105.5(T)92.3(-26\) - provides a total score)]TJ T* -0.001 Tc 0.125 Tw (for disturbed eating attitudes and behaviors based on)Tj T* -0.0036 Tc 0.0415 Tw (dieting, bulimia and food preoccupation, and oral con-)Tj 0 -1.398 TD -0.0159 Tc 0 Tw (trol.)Tj 14 0 0 14 54 422.64 Tm 0 Tc ()Tj 10 0 0 10 72 422.64 Tm -0.0038 Tc -0.01 Tw (Parental Bonding Instrument \(PBI\) - assesses parenting)Tj T* -0.0037 Tc -0.0012 Tw (attitudes based on two dimensions of care and overpro-)Tj 0 -1.401 TD 0.0041 Tc 0 Tw (tection.)Tj 14 0 0 14 54 378.66 Tm 0 Tc ()Tj 10 0 0 10 72 378.66 Tm -0.0034 Tc -0.055 Tw (Impact of Event Scale- Revised \(IES-R\) - was only used)Tj T* -0.0036 Tc 0.1 Tw (to assess participants who reported experiencing trau-)Tj T* 0.025 Tc 0.125 Tw (matic events. This measure assesses hyperarousal,)Tj 0 -1.398 TD -0.004 Tc -0.062 Tw (heightened startle response, difficulty concentrating and)Tj 0 -1.401 TD -0.0032 Tc 0.045 Tw (hypervigilance, intrusion, and avoidance.)Tj /TT1 1 Tf 11 0 0 11 54 290.64 Tm 0.0154 Tc 0 Tw [(RESUL)83.6(TS)]TJ 0 -1.4536 TD 0.0044 Tc 0.1246 Tw [(T)76.8(rauma exposur)12.6(e and PTSD pr)12.6(evalence)]TJ /TT2 1 Tf 14 0 0 14 54 258.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 258.66 Tm -0.0036 Tc -0.0407 Tw (The findings revealed that 76.5% of participants experi-)Tj 0 -1.401 TD -0.044 Tw (enced a traumatic event, and most)Tj /TT1 1 Tf 13.269 0 TD 0 Tc 0 Tw ( )Tj /TT2 1 Tf 0.207 0 TD -0.0041 Tc -0.045 Tw (were exposed to mul-)Tj -13.476 -1.401 TD -0.0045 Tc -0.06 Tw (tiple traumas.)Tj 14 0 0 14 54 214.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 214.65 Tm -0.0036 Tc -0.03 Tw (Sexual abuse \(54.7%\), victim of violence \(45.3%\), con-)Tj T* -0.0037 Tc -0.0564 Tw (fronted with traumatic news and child maltreatment, ex-)Tj 0 -1.398 TD -0.007 Tc -0.0625 Tw (cluding neglect \(32.8%\).)Tj 14 0 0 14 54 170.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 170.64 Tm -0.004 Tc -0.0621 Tw (Fifteen \(32.8%\) of those who had experienced traumatic)Tj T* -0.0074 Tc (events were diagnosed with PTSD \(using the MINI-kid\).)Tj 0 -1.401 TD -0.0038 Tc -0.0566 Tw (This group was reassessed using the CAPS and of those,)Tj T* -0.0036 Tc 0.0411 Tw (15 were diagnosed as having full PTSD, 2 with partial)Tj 0 -1.398 TD -0.004 Tc -0.0167 Tw (PTSD and 2 as not having PTSD.)Tj /TT1 1 Tf 11 0 0 11 309 722.64 Tm -0.0045 Tc 0.075 Tw (PTSD and comorbidity)Tj /TT2 1 Tf 14 0 0 14 309 706.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 706.65 Tm -0.0075 Tc -0.0625 Tw (Participants with PTSD showed higher comorbidity than)Tj 0 -1.401 TD -0.0037 Tc -0.0486 Tw (those not exposed to trauma with: depression \()Tj /TT7 1 Tf 18.129 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0026 Tc -0.05 Tw [( = .002\),)]TJ -18.624 -1.398 TD -0.0094 Tc -0.06 Tw (panic disorder \()Tj /TT7 1 Tf 6.009 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.492 0 TD -0.0094 Tc -0.0625 Tw [( = .001\), agoraphobia \()]TJ /TT7 1 Tf 8.709 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.489 0 TD -0.0089 Tc -0.0634 Tw [( = .016\), separa-)]TJ -15.699 -1.401 TD -0.0045 Tc -0.0617 Tw (tion anxiety disorder \()Tj /TT7 1 Tf 8.574 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.492 0 TD -0.0047 Tc -0.062 Tw [( = .002\), social phobia \()]TJ /TT7 1 Tf 9.108 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.492 0 TD -0.0047 Tc -0.0625 Tw [( = .000\),)]TJ -18.666 -1.401 TD -0.0061 Tc 0 Tw (OCD \()Tj /TT7 1 Tf 2.67 0 TD 0 Tc (p)Tj /TT2 1 Tf 0.495 0 TD -0.0033 Tc -0.0039 Tw ( = .011\), conduct disorder \()Tj /TT7 1 Tf 10.815 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0027 Tc -0.0031 Tw ( = .045\), psychotic)Tj -14.475 -1.398 TD -0.0037 Tc -0.0375 Tw (disorder-current episode \()Tj /TT7 1 Tf 10.161 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0029 Tc -0.04 Tw [( = .027\).)]TJ 14 0 0 14 309 620.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 620.64 Tm 0.0185 Tc 0.125 Tw [(Participants with PTSD were more likely to report)]TJ 0 -1.398 TD -0.0034 Tc -0.0274 Tw [(comorbidities of panic disorder)35.6(, social anxiety disorder)35.6(,)]TJ 0 -1.401 TD 0.0111 Tc 0.125 Tw (social phobia and psychotic disorder than those not)Tj T* -0.0044 Tc -0.01 Tw (diagnosed with PTSD.)Tj 14 0 0 14 309 562.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 562.65 Tm -0.0035 Tc 0.0517 Tw (Participants with PTSD reported a significantly higher)Tj T* -0.007 Tc -0.0625 Tw (risk of suicidality than those without exposure to trauma.)Tj /TT1 1 Tf 11 0 0 11 309 516.66 Tm 0.0131 Tc 0.125 Tw (Comparisons of self-questionnaires)Tj /TT2 1 Tf 14 0 0 14 309 500.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 500.64 Tm 0.0096 Tc 0.125 Tw (Participants with PTSD showed significantly higher)Tj 0 -1.398 TD -0.0039 Tc 0.0057 Tw (scores than those without PTSD or trauma exposure on)Tj 0 -1.401 TD -0.0043 Tc 0.0175 Tw (the: DSD \()Tj /TT7 1 Tf 4.329 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0034 Tc 0.0187 Tw [( <.01\), total EA)104.6(T)91.4(-26 \()]TJ /TT7 1 Tf 8.592 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0035 Tc 0.0202 Tw [( < .01\), EA)107.5(T)91.3(-26 diet)]TJ -13.911 -1.401 TD -0.0475 Tw (factor subscale \()Tj /TT7 1 Tf 6.399 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.495 0 TD -0.0038 Tc -0.0497 Tw [( < .05\), EA)104.2(T)91(-26 bulimia/food preoccu-)]TJ -6.894 -1.398 TD -0.0036 Tc -0.0133 Tw (pation factor subscale \()Tj /TT7 1 Tf 9.18 0 TD -0.006 Tc 0 Tw (p )Tj /TT2 1 Tf 0.729 0 TD -0.0027 Tc -0.015 Tw (< .01\).)Tj 14 0 0 14 309 428.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 428.64 Tm 0.0096 Tc 0.125 Tw (Participants with PTSD showed significantly higher)Tj 0 -1.398 TD -0.0038 Tc 0.0032 Tw [(scores than those without trauma exposure on the EA)107.2(T)91(-)]TJ 0 -1.401 TD -0.0033 Tc -0.049 Tw (26 oral control subscale \(p <.05\).)Tj 14 0 0 14 309 384.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 384.66 Tm -0.0052 Tc -0.0621 Tw (No statistically significant differences were found in im-)Tj T* -0.0026 Tc 0.125 Tw (pulsiveness and parental attitudes.)Tj /TT1 1 Tf 11 0 0 11 309 338.64 Tm -0.0031 Tc (Prediction of PTSD diagnosis and)Tj 0 -1.2709 TD 0.0132 Tc 0 Tw (symptomatology)Tj /TT2 1 Tf 14 0 0 14 309 308.64 Tm 0 Tc ()Tj 10 0 0 10 327 308.64 Tm -0.0035 Tc -0.0559 Tw (Three significant predictors/risk factors for the develop-)Tj 0 -1.398 TD -0.004 Tc -0.0314 Tw (ment of PTSD among those with trauma exposure.)Tj 14 0 0 14 309 278.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 278.64 Tm -0.0038 Tc 0.0694 Tw (DSD scores predicted the development of PTSD \(p <.)Tj T* -0.0665 Tc 0 Tw (01\))Tj 14 0 0 14 309 248.64 Tm 0 Tc ()Tj 10 0 0 10 327 248.64 Tm -0.0116 Tc -0.0621 Tw (Lower maternal protection and maternal care scores were)Tj T* -0.0033 Tc 0.0199 Tw [(found to be risk factors.)]TJ 14 0 0 14 309 218.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 218.64 Tm -0.0036 Tc -0.0033 Tw [(DSD \(p<.001\) and EA)104.4(T)94.2(-26 oral control scores \(p < .08\))]TJ T* -0.0092 Tc -0.0622 Tw (were found to predict the severity of PTSD related symp-)Tj 0 -1.401 TD -0.005 Tc 0 Tw (toms.)Tj /TT1 1 Tf 11 0 0 11 309 158.64 Tm -0.0004 Tc 0.1254 Tw (Features of PTSD in female offenders)Tj 0 -1.2709 TD 0.0088 Tc 0.125 Tw (determined using CAPS)Tj /TT2 1 Tf 14 0 0 14 309 128.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 327 128.64 Tm -0.0034 Tc -0.0034 Tw (Comorbid panic disorder significantly increased the in-)Tj 0 -1.398 TD -0.0032 Tc -0.0585 Tw [(tensity scores of criteria B\(intrusive recollection\), and B)]TJ 0 -1.401 TD 0.0332 Tc 0.125 Tw (\(intrusive arousal\) + C \(avoidance/numbing\) + D)Tj T* -0.0004 Tc 0 Tw (\(hyperarousal\).)Tj ET endstream endobj 324 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 326 0 obj << /Length 8205 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD 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support and cor-)Tj 0 -1.398 TD 0.0415 Tc 0.125 Tw (rectional education are recommended for female)Tj 0 -1.401 TD 0.0027 Tc 0 Tw (offenders.)Tj /TT1 1 Tf 11 0 0 11 66 368.64 Tm 0.0101 Tc (Limitations)Tj /TT2 1 Tf 14 0 0 14 66 352.65 Tm 0 Tc ()Tj 10 0 0 10 84 352.65 Tm -0.0038 Tc -0.0275 Tw (Small sample size and no control group)Tj 14 0 0 14 66 336.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 336.66 Tm -0.0038 Tc 0.0025 Tw (Limitations in accurate diagnosis using the MINI)Tj 14 0 0 14 66 320.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 320.64 Tm -0.0037 Tc 0.0657 Tw (The authors suggest that future research should exam-)Tj 0 -1.398 TD -0.0248 Tc 0 Tw (ine:)Tj 0.6 -1.602 TD -0.003 Tc -0.0216 Tw [(o)-703(Personality deviations \(due to the difficulty assess-)]TJ 1.2 -1.398 TD -0.0032 Tc 0.0687 Tw (ing personality disorders in adolescents\).)Tj -1.2 -1.602 TD -0.0034 Tc 0.095 Tw [(o)-703.4(Links between suicidal risk, impulsivity and sub-)]TJ 1.2 -1.398 TD 0.0043 Tc 0.125 Tw (stance use.)Tj -1.2 -1.602 TD -0.0037 Tc 0.0775 Tw [(o)-703.7(Dissociative disorders in adolescent offenders)]TJ 0 -1.599 TD 0.0192 Tc 0.1249 Tw [(o)-680.8(The relationship between eating behaviors and)]TJ 1.2 -1.401 TD -0.0401 Tc 0 Tw (PTSD)Tj -1.2 -1.599 TD -0.004 Tc -0.0238 Tw [(o)-704(Relationship between developmental disorders and)]TJ 1.2 -1.401 TD 0.001 Tc 0.125 Tw (offense patterns.)Tj ET 3.99 w /GS1 gs 66 145.995 m 303 145.995 l S BT /TT1 1 Tf 11 0 0 11 66 126.99 Tm /GS2 gs 0.0484 Tc 0.1254 Tw [(Denson, )16.1(T)74.5(.)3.8(F)92(., Marshall, G)113.9(.N., Schell, )18.8(T)74.5(.L., &)]TJ 0 -1.1809 TD 0.0061 Tc (Jaycox, L.H. \(2007\). Predictors of Posttraumatic)Tj T* -0.0038 Tc 0.0496 Tw [(Distr)12.6(ess 1 )34.6(Y)112.9(ear)15.3( after)12.6( Exposur)15.3(e to Community )12.8(V)42(io-)]TJ 23.1818 56.5773 TD 0.0014 Tc 0.1248 Tw [(lence: )14.8(The Impor)-9.5(tance of )53(Acute Symptom Sever)34.1(-)]TJ 0 -1.1836 TD -0.0022 Tc 0 Tw [(ity)52.3(. )]TJ /TT6 1 Tf 1.6309 0 TD -0.0035 Tc 0.0864 Tw [(Journal of Consulting and Clinical Psychology)32(,)]TJ ET 0.99 w /GS1 gs 321 688.845 m 558 688.845 l S BT 11 0 0 11 321 697.35 Tm /GS2 gs 0.0191 Tc 0.125 Tw (75 \(5\), )Tj /TT1 1 Tf 3.3191 0 TD 0.0172 Tc 0 Tw (683-692.)Tj -3.3191 -3.9409 TD -0.008 Tc 0.1236 Tw [(TYPE OF)27.4( )46.5(A)10(R)27.5(TICLE)]TJ /TT2 1 Tf 14 0 0 14 321 638.01 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 638.01 Tm -0.0083 Tc -0.0625 Tw (Original empirical investigation. Longitudinal Research.)Tj /TT1 1 Tf 11 0 0 11 321 606 Tm 0.0059 Tc 0.1263 Tw [(OBJECTIVES/PURPOSE OF)33.2( )14(THE )47.4(A)10.2(R)27.7(TICLE)]TJ /TT2 1 Tf 14 0 0 14 321 590.01 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 590.01 Tm -0.0062 Tc -0.0621 Tw [(T)73.6(o)0( simultaneously examine the impact of four predictors)]TJ 0 -1.401 TD -0.0034 Tc 0.015 Tw (of PTSD diagnosis and severity:)Tj 14 0 0 14 321 560.01 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 560.01 Tm -0.0035 Tc 0.03 Tw [( demographic characteristics, pretraumatic psychologi-)]TJ T* -0.0033 Tc 0.0493 Tw (cal factors, characteristics of the trauma, and reactions)Tj T* -0.0035 Tc -0.0025 Tw (to the trauma.)Tj 14 0 0 14 321 516 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 516 Tm -0.0034 Tc -0.0164 Tw [(T)73.4(o)0( control for issues such as the presence of acute post-)]TJ T* 0.0093 Tc 0.125 Tw (traumatic distress and biases due to the use of only)Tj 0 -1.398 TD -0.0027 Tc (retrospective measures.)Tj 14 0 0 14 321 471.99 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 471.99 Tm -0.0033 Tc 0.0212 Tw [(T)73.5(o)0( replicate past findings that indicated risk factors as-)]TJ T* -0.0034 Tc 0.0193 Tw (sessed a short time after a traumatic experience predict)Tj 0 -1.401 TD -0.0032 Tc -0.043 Tw (PTSD symptom severity after 12 months.)Tj 14 0 0 14 321 428.01 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 428.01 Tm -0.0036 Tc 0.0679 Tw [(T)73.2(o)0( determine whether these risk factors maintain their)]TJ T* -0.0034 Tc -0.0285 Tw (significance after adjusting for initial levels of posttrau-)Tj T* -0.0037 Tc 0.03 Tw (matic distress.)Tj 14 0 0 14 321 384 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 384 Tm -0.0036 Tc -0.0269 Tw [(T)73.2(o)0( evaluate the extent to which long term posttraumatic)]TJ T* -0.0046 Tc -0.0625 Tw (symptoms are explained by acute posttraumatic distress.)Tj /TT1 1 Tf 11 0 0 11 321 338.01 Tm 0.0434 Tc 0 Tw (METHOD)Tj 0 -1.4564 TD 0.0026 Tc (Participants)Tj /TT2 1 Tf 14 0 0 14 321 306 Tm 0 Tc ()Tj 10 0 0 10 339 306 Tm -0.0003 Tc 0.125 Tw (Hospital admissions between October 1998 and June)Tj 0 -1.401 TD -0.007 Tc -0.0622 Tw (2000- screened for blunt or penetrating trauma at a Level)Tj 0 -1.398 TD -0.0119 Tc -0.0625 Tw [(I trauma facility)63.1(.)]TJ 14 0 0 14 321 261.99 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 261.99 Tm -0.0034 Tc -0.0465 Tw (Persons with injuries not attributable to community vio-)Tj T* -0.0097 Tc -0.0625 Tw (lence were ineligible.)Tj 14 0 0 14 321 231.99 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 231.99 Tm -0.0035 Tc -0.0328 Tw (Of 653 screened, 423 were deemed eligible. Of the 423,)Tj T* -0.0519 Tw [(413 \(98%\) chose to participate in the baseline interview)59.4(.)]TJ 14 0 0 14 321 201.99 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 201.99 Tm -0.0036 Tc 0.1242 Tw (57% of the patients sustained injuries from gunshots,)Tj T* -0.0033 Tc 0.1185 Tw (the remaining patients received injury from blunt ob-)Tj 0 -1.401 TD -0.0034 Tc 0.0332 Tw [(jects \(closed fists or baseball bats\) or other penetrating)]TJ T* -0.0037 Tc 0.05 Tw (objects \(knives\).)Tj 14 0 0 14 321 144 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 144 Tm -0.0041 Tc -0.062 Tw (Mean age = 25.10 years, )Tj /TT7 1 Tf 9.684 0 TD -0.0162 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.206 0 TD -0.0041 Tc -0.0625 Tw [( = 6.03.)]TJ 14 0 0 14 321 128.01 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 128.01 Tm -0.0078 Tc -0.0622 Tw (Ninety - four percent were male, 41% high school gradu-)Tj 0 -1.401 TD 0.0318 Tc 0 Tw (ates)Tj 14 0 0 14 321 98.01 Tm 0 Tc ()Tj 10 0 0 10 339 98.01 Tm -0.0032 Tc 0.085 Tw (Seventy - nine percent earned $1500 or less in the 30)Tj T* -0.0026 Tc 0.0033 Tw [(days preceding their injury)60.4(.)]TJ ET endstream endobj 327 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT6 56 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 329 0 obj << /Length 8401 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 54 59.745 m 546 59.745 l S BT /F1 1 Tf 8 0 0 8 54.99 41.64 Tm 0 0 0 1 k /GS2 gs -0.0049 Tc 0.1229 Tw [(80 )]TJ /TT3 1 Tf 2.295 0 TD -0.0057 Tc 0.125 Tw (Selected Annotated Journal Resources)Tj /TT2 1 Tf 14 0 0 14 54 722.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 722.64 Tm -0.004 Tc -0.0622 Tw (Seventy-eight percent were Hispanic \(47% born in U.S.,)Tj 0 -1.398 TD -0.0138 Tc -0.0623 Tw [(38% in Mexico, 15% in Central )46.4(America\).)]TJ /TT1 1 Tf 11 0 0 11 54 676.65 Tm 0.0242 Tc 0 Tw (Procedure)Tj /TT2 1 Tf 14 0 0 14 54 660.66 Tm 0 Tc ()Tj 10 0 0 10 72 660.66 Tm -0.0034 Tc -0.042 Tw (Face-to-face structured interviews conducted by trained)Tj 0 -1.401 TD -0.0063 Tc -0.062 Tw (lay interviewers. \(English 72%, Spanish, 28%\).)Tj 14 0 0 14 54 630.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 630.66 Tm -0.0033 Tc 0.0636 Tw (Initial interview occurred within days of the interview)Tj T* -0.0032 Tc 0.0028 Tw (\(median interval = 5 days\). Subsequent face-to-face in-)Tj T* 0.125 Tw (home interviews were conducted at 3 and 12 months)Tj 0 -1.398 TD -0.0037 Tc 0.005 Tw [(following initial interview)62.3(. Participants were given $25)]TJ 0 -1.401 TD -0.0039 Tc -0.0483 Tw [(for each completed interview)59.1(.)]TJ 14 0 0 14 54 558.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 558.66 Tm -0.0074 Tc -0.0625 Tw (At the 12 month interview- PTSD symptom severity was)Tj T* -0.0035 Tc 0.03 Tw (the outcome of interest.)Tj 14 0 0 14 54 528.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 528.66 Tm -0.0038 Tc -0.025 Tw (Of the 413 baseline interviewees, 304 \(74%\) completed)Tj T* -0.0235 Tw [(12 month follow-up interview)59.1(. For participants who did)]TJ T* -0.0037 Tc 0.1221 Tw (not complete 12 month follow-up, 3 month symptom)Tj 0 -1.398 TD -0.0034 Tc -0.0031 Tw (severity information was used to estimate 12 month se-)Tj 0 -1.401 TD -0.0023 Tc -0.035 Tw (verity levels.)Tj 14 0 0 14 54 456.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 456.66 Tm 0.0021 Tc 0.125 Tw (Three participants were removed because of missing)Tj T* 0.0086 Tc 0 Tw (data.)Tj 14 0 0 14 54 426.66 Tm 0 Tc ()Tj 10 0 0 10 72 426.66 Tm -0.0036 Tc -0.0125 Tw (The final sample consisted of 333 participants.)Tj /TT1 1 Tf 11 0 0 11 54 394.65 Tm 0.0557 Tc 0 Tw (Measures)Tj /TT2 1 Tf 14 0 0 14 54 378.66 Tm 0 Tc ()Tj 10 0 0 10 72 378.66 Tm -0.0046 Tc -0.06 Tw (Demographic variables)Tj 0.6 -1.602 TD -0.0033 Tc 0.0353 Tw [(o)-703.3(Gender)38.7(, age, ethnicity)59.7(, income, educational attain-)]TJ 1.2 -1.398 TD -0.0165 Tc 0 Tw (ment)Tj 0 -1.602 TD -0.0037 Tc 0.03 Tw [()-553.6(Ethnicity coded as Hispanic/Non-Hispanic)]TJ 0 -1.599 TD -0.0038 Tc 0.0808 Tw [()-553.7(Education coded as completed high school/ did)]TJ 0.9 -1.401 TD 0.0367 Tw (not complete high school.)Tj -0.9 -1.599 TD 0.0066 Tc 0.125 Tw [()-543.3(Level of acculturation was assessed using the)]TJ 0.9 -1.401 TD -0.0036 Tc -0.01 Tw [(choice of language for the interview)59.4(.)]TJ 14 0 0 14 54 256.65 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 72 256.65 Tm -0.0034 Tc 0.015 Tw (Pretraumatic psychological factors)Tj 0.6 -1.599 TD -0.0037 Tc -0.005 Tw [(o)-703.7(Prior exposure to traumatic events)]TJ 1.2 -1.602 TD [()-553.6(Lifetime community violence exposure assessed)]TJ 0.9 -1.398 TD 0.0263 Tc 0.125 Tw (using 18 items modeled after the Survey of)Tj 0 -1.401 TD 0.0167 Tc 0.1254 Tw [(Children)52.7(s Exposure to Community )17.1(V)63.9(iolence)]TJ T* -0.0663 Tc 0 Tw (\(SCECV\).)Tj -0.9 -1.599 TD -0.0025 Tc 0.125 Tw [()-552.4(T)74.3(o reduce respondent burden, they were asked)]TJ 0.9 -1.401 TD -0.0033 Tc -0.002 Tw (to dichotomously respond yes or no to questions)Tj 0 -1.398 TD -0.0036 Tc -0.018 Tw (regarding direct exposure \(the attack responsible)Tj 0 -1.401 TD 0.003 Tw (for current hospitalization was not included\).)Tj /F30 1 Tf 4 0 0 4 102 108.66 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 10 0 0 10 111 108.66 Tm -0.0038 Tc 0.0459 Tw (Index of violence exposure \(sum of endorse-)Tj T* -0.0043 Tc 0 Tw (ments\))Tj 9 0 0 9 114 80.64 Tm -0.0039 Tc 0.0206 Tw [()-653.8(\(M = 5.58, SD = 3.14, Range = 0 to 16\).)]TJ /F30 1 Tf 4 0 0 4 357 722.64 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 10 0 0 10 366 722.64 Tm -0.0041 Tc -0.0262 Tw (Other lifetime trauma exposure \(non-commu-)Tj 0 -1.398 TD -0.0032 Tc -0.0338 Tw (nity violence related trauma exposure\).)Tj 9 0 0 9 369 694.65 Tm -0.0039 Tc 0.02 Tw [()-653.8(\(M = 1.40, SD = 1.16, Range = 0 to 6\))]TJ 10 0 0 10 333 679.65 Tm -0.004 Tc 0 Tw [(o)-704(Life Stressors)]TJ 1.2 -1.599 TD -0.0037 Tc -0.02 Tw [()-553.6(Nine relevant items taken from Life Experiences)]TJ 0.9 -1.401 TD -0.0031 Tc -0.0392 Tw (Survey \(LES\). Respondents indicated if they had)Tj T* -0.0037 Tc 0.081 Tw (experiences including dissolution of a romantic)Tj 0 -1.398 TD -0.0217 Tc -0.0625 Tw (relationship, a major health problem, spending time)Tj 0 -1.401 TD -0.0128 Tc -0.0613 Tw (in jail, losing a job\()Tj /TT7 1 Tf 7.281 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.813 0 TD -0.0124 Tc -0.0616 Tw [( = 2.08, )]TJ /TT7 1 Tf 3.021 0 TD -0.0222 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.191 0 TD -0.0132 Tc -0.063 Tw [( = 1.68, Range = 0)]TJ -12.306 -1.401 TD -0.0052 Tc -0.06 Tw (to 7\).)Tj -2.1 -1.599 TD -0.0034 Tc -0.005 Tw [(o)-703.4(Pretraumatic psychological symptoms)]TJ 1.2 -1.599 TD -0.0113 Tc -0.0625 Tw [()-561.2(Recent history of major depression and dysthymia)]TJ /F30 1 Tf 4 0 0 4 357 545.64 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 10 0 0 10 366 545.64 Tm -0.0036 Tc 0.08 Tw (Assessed by three dichotomous items devel-)Tj 0 -1.398 TD -0.0072 Tc -0.0625 Tw (oped by Rost, Burnam, & Smith \(1993\).)Tj /F30 1 Tf 4 0 0 4 357 515.64 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 10 0 0 10 366 515.64 Tm -0.0036 Tc 0.0664 Tw (Items were summed to create an index \()Tj /TT7 1 Tf 16.296 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.825 0 TD 0.065 Tc ( =)Tj -17.121 -1.398 TD -0.009 Tc (0.55, )Tj /TT7 1 Tf 2.136 0 TD -0.0222 Tc (SD)Tj /TT2 1 Tf 1.194 0 TD -0.0099 Tc -0.0622 Tw [( = 0.78, Range = 0 to 2\).)]TJ 9 0 0 9 369 487.65 Tm -0.0041 Tc 0.0244 Tw [()-654(In the past year have you had 2 weeks or more)]TJ 1 -1.2233 TD -0.0043 Tc -0.0569 Tw (during which you felt sad, blue, or depressed; or)Tj 0 -1.22 TD 0.0541 Tw (when you lost all interest or pleasure in things)Tj 0 -1.2233 TD -0.0034 Tc 0.03 Tw [(you usually cared about or enjoyed?)]TJ -1 -1.4433 TD -0.0041 Tc -0.0311 Tw [()-654(Have you had 2 or more years in your life when)]TJ 1 -1.2233 TD -0.0044 Tc -0.0111 Tw (you felt sad or depressed most days even if you)Tj T* -0.006 Tc 0.0583 Tw (felt okay sometimes?)Tj -1 -1.4433 TD -0.0052 Tc -0.05 Tw [()-655.1(Have you felt depressed or sad much of the time)]TJ 1 -1.2233 TD -0.0033 Tc 0.0648 Tw (in the past year?)Tj 10 0 0 10 333 380.64 Tm -0.0032 Tc 0.03 Tw [(o)-703.2(Personality variables)]TJ 1.2 -1.599 TD -0.0033 Tc -0.0157 Tw [()-553.2(Participants were asked to report what they were)]TJ 0.9 -1.401 TD -0.0142 Tc -0.0625 Tw (generally like before the attack to limit biases from)Tj 0 -1.398 TD 0.0029 Tc 0.125 Tw (acute distress.)Tj -0.9 -1.602 TD -0.0106 Tc -0.0622 Tw [()-560.5(Trait optimism was measured with the 6-item Life)]TJ 0.9 -1.398 TD -0.0038 Tc -0.017 Tw [(Orientation )17.2(T)73(est- Revised, with response options)]TJ 0 -1.401 TD -0.003 Tc -0.01 Tw (ranging from 1 \(strongly disagree\) to 5 \(strongly)Tj T* -0.0079 Tc 0 Tw (agree\).)Tj /F30 1 Tf 4 0 0 4 357 262.65 Tm 0 Tc ()Tj /TT2 1 Tf 10 0 0 10 366 262.65 Tm -0.0036 Tc -0.0162 Tw (Optimists generally expect positive outcomes)Tj T* -0.0033 Tc 0.035 Tw (\(I usually expected the best to happen\).)Tj -2.1 -1.599 TD -0.0047 Tc -0.0621 Tw [()-554.6(Trait neuroticism measured with 5 items from the)]TJ 0.9 -1.401 TD -0.0036 Tc 0.1069 Tw [(NEO Five-Factor Inventory)62.4(. )50.3(Abbreviated to re-)]TJ 0 -1.398 TD -0.0001 Tc 0.125 Tw (duce respondent burden.)Tj /F30 1 Tf 4 0 0 4 357 188.64 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 10 0 0 10 366 188.64 Tm -0.0035 Tc 0.0664 Tw (Asked to rate the personal relevance of each)Tj T* -0.0034 Tc 0.058 Tw (statement ranging from 1 \(strongly disagree\))Tj 0 -1.401 TD -0.0027 Tc -0.0016 Tw (to 5 \(strongly agree\).)Tj /F30 1 Tf 4 0 0 4 357 144.66 Tm 0 Tc 0 Tw ()Tj /TT2 1 Tf 10 0 0 10 366 144.66 Tm 0.0075 Tc 0.125 Tw (Individuals high on neuroticism tend to be)Tj T* -0.0046 Tc -0.062 Tw (emotionally labile and experience negative af-)Tj T* -0.0038 Tc 0.125 Tw (fect and cognition. \(Sometimes I felt com-)Tj 0 -1.398 TD -0.0029 Tc 0.0249 Tw [(pletely worthless\).)]TJ ET endstream endobj 330 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F30 263 0 R /TT1 8 0 R /TT2 9 0 R /TT3 10 0 R /TT7 57 0 R >> /ExtGState << /GS1 12 0 R /GS2 13 0 R >> >> endobj 332 0 obj << /Length 9160 >> stream 0 0 0 1 K 0 J 0 j 0.51 w 10 M []0 d /GS1 gs 1 i 66 59.745 m 558 59.745 l S BT /TT3 1 Tf 8 0 0 8 427.5 42.6 Tm 0 0 0 1 k /GS2 gs -0.0051 Tc 0.034 Tw [(IJEMH Vol. 10, No. 1 2008 )]TJ /F1 1 Tf 15.3375 0 TD -0.0132 Tc 0 Tw (81)Tj /TT2 1 Tf 14 0 0 14 66 722.64 Tm 0 Tc ()Tj 10 0 0 10 84 722.64 Tm -0.0036 Tc 0.0113 Tw (Characteristics of the traumatic event)Tj 0.6 -1.599 TD -0.0068 Tc -0.0619 Tw [(o)-706.8(Event characteristics were obtained from computer-)]TJ 1.2 -1.401 TD -0.0074 Tc -0.0625 Tw (ized medical records.)Tj -1.2 -1.599 TD -0.003 Tc 0.0478 Tw [(o)-703(Injury Severity Scores \(ISS\) used to obtain objec-)]TJ 1.2 -1.401 TD -0.0028 Tc 0.1126 Tw [(tive injury severity)63.2(. \(range = 1 to 75 with higher)]TJ 0 -1.398 TD -0.0033 Tc 0.0633 Tw (scores indicating higher probability of death from)Tj 0 -1.401 TD -0.0099 Tc -0.06 Tw (the injuries \()Tj /TT7 1 Tf 4.8 0 TD 0 Tc 0 Tw (M)Tj /TT2 1 Tf 0.816 0 TD -0.0087 Tc -0.0634 Tw [( = 9.03, )]TJ /TT7 1 Tf 3.045 0 TD -0.0222 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.194 0 TD -0.0096 Tc -0.0625 Tw [( = 8.89\).)]TJ -9.855 -1.599 TD -0.0035 Tc 0.0928 Tw [()-553.4(A)0( score of 9 is considered mild to moderate in)]TJ 0.9 -1.401 TD 0.0085 Tc 0 Tw (severity)Tj -2.1 -1.599 TD -0.0037 Tc -0.0031 Tw [(o)-703.7(Mechanism of assault was coded as gunshot vs. all)]TJ 1.2 -1.401 TD -0.0043 Tc -0.005 Tw (other mechanisms.)Tj -1.2 -1.599 TD -0.0033 Tc -0.0607 Tw [(o)-703.3(Mean length of hospitalization was 6.96 days \()]TJ /TT7 1 Tf 19.344 0 TD -0.0132 Tc 0 Tw (SD)Tj /TT2 1 Tf 1.212 0 TD -0.07 Tc ( =)Tj -19.356 -1.401 TD -0.01 Tc -0.062 Tw (8.06, Range = 0 to 66\).)Tj 14 0 0 14 66 528.66 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 84 528.66 Tm -0.0037 Tc 0.0325 Tw (Reactions to the traumatic event)Tj 0.6 -1.602 TD -0.004 Tc -0.04 Tw [(o)-704(Peritraumatic dissociation)]TJ 1.2 -1.599 TD -0.0037 Tc 0.0178 Tw [()-553.6(Assessed using a modified 8-item version of the)]TJ 0.9 -1.401 TD -0.0039 Tc 0.1 Tw (10-item Peritraumatic Dissociative Experiences)Tj 0 -1.398 TD -0.0053 Tc -0.0621 Tw (Questionnaire \(PDEQ\). 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Three oth-)Tj T* -0.0219 Tw [(ers were missing extensive data and were dropped from)]TJ 0 -1.398 TD 0.014 Tc 0 Tw (analyses.)Tj 14 0 0 14 321 590.64 Tm 0 Tc ()Tj 10 0 0 10 339 590.64 Tm -0.0038 Tc 0.1107 Tw (For 32 participants who completed a PTSD symptom)Tj T* -0.0037 Tc 0.0505 Tw (assessment at the 3 month follow up but were missing)Tj 0 -1.401 TD -0.0038 Tc -0.06 Tw (data from month 12, a data resampling technique known)Tj T* -0.0037 Tc -0.018 Tw (as hot decking was used for imputation of the 12 month)Tj 0 -1.398 TD -0.003 Tc 0.1092 Tw [(outcome variable. 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of participants met screening crite-)]TJ 0 -1.401 TD -0.0034 Tc 0.045 Tw (ria for PTSD at the 5-day assessment \(excluding dura-)Tj T* -0.0037 Tc -0.0625 Tw (tion\), and 20% met criteria at the 12-month follow-up.)Tj 0.6 -1.599 TD 0.0109 Tc 0.125 Tw [(o)-689.1(There was a statistically significant decrease in)]TJ 1.2 -1.401 TD -0.0189 Tc -0.0622 Tw (symptom severity for the sample over time \()Tj /TT7 1 Tf 16.5 0 TD 0 Tc 0 Tw (p)Tj /TT2 1 Tf 0.48 0 TD -0.019 Tc -0.0625 Tw [( < .001\),)]TJ -16.98 -1.398 TD -0.0033 Tc 0.0133 Tw (but the effect size was small \()Tj /TT7 1 Tf 11.865 0 TD -0.006 Tc 0 Tw (d )Tj /TT2 1 Tf 0.759 0 TD -0.0034 Tc 0.015 Tw (= -.31\), suggesting)Tj -12.624 -1.401 TD -0.0037 Tc -0.006 Tw (that although symptom levels decreased somewhat)Tj T* -0.0027 Tc 0.0221 Tw (they stayed relatively constant over the 12 months)Tj 0 -1.398 TD -0.0056 Tc -0.0625 Tw (following the trauma.)Tj 14 0 0 14 321 224.64 Tm 0 Tc 0 Tw ()Tj 10 0 0 10 339 224.64 Tm -0.0064 Tc -0.06 Tw 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[(symptom severity)60.4(.)]TJ -0.9 -1.602 TD -0.0035 Tc 0.0784 Tw [()-553.4(Older age was associated with increased symp-)]TJ 0.9 -1.398 TD -0.0029 Tc -0.025 Tw [(tom severity)60.1(.)]TJ -2.1 -1.602 TD -0.0034 Tc 0.015 Tw [(o)-703.4(Pretraumatic psychological factors)]TJ 1.2 -1.599 TD -0.0043 Tc 0.0975 Tw [()-554.2(When combined with demographic characteris-)]TJ 0.9 -1.401 TD -0.0036 Tc 0.0806 Tw (tics- explained 8% of the variance in 12 month)Tj 0 -1.398 TD -0.0625 Tw [(PTSD symptom severity)59.5(.)]TJ -0.9 -1.602 TD -0.0114 Tc [()-561.3(Only a recent history of depression prior to trauma)]TJ 0.9 -1.398 TD -0.0036 Tc 0.0022 Tw (had a significant unique association with the 12-)Tj 0 -1.401 TD -0.045 Tw [(month PTSD symptom severity)59.5(.)]TJ -2.1 -1.599 TD 0.0113 Tw [(o)-703.6(Characteristics of the traumatic event)]TJ 1.2 -1.602 TD -0.034 Tw [()-553.5(Inclusion improved model prediction by 2%.)]TJ 0 -1.599 TD -0.0023 Tc 0.0643 Tw [()-552.2(Only injury severity was uniquely related to 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