REGISTRATION
FORM
CISM: Advanced
Group Crisis Intervention (PN58)
(Please type or print; photocopy for
additional registrants; telephone
registrations cannot be accepted.)
SS#: (Last five digits only): __ - __ __ __ __
Name______________________________________
Agency_____________________________________
Address ____________________________________
City ___________________State____ Zip _________
Phone ______________________________________
Email_______________________________________
County______________________________________
Specialty/Degree(s)___________________________
Are you a WPIC employee? □Yes □ No
For Continuing Education Purposes,
please check if you are:
|
□
NBCC
Counselor (NBCC #_________) |
|
|
□
Educator
(ACT 48) |
|
|
□
Nurse |
□
Psychologist |
|
□
SW/LPC/LMFT |
□
|
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□
CPRP |
□
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Tuition: $________ Method
of Payment:
□
UPMC Account
Transfer □American
Express
□ MasterCard □ Discover □Visa □ Check #______
(Payable to OERP/WPIC)
To be completed by credit card users
only:
Card Number _______________________________
Expiration Date: __________Security
Code: _______
Signature: __________________________________
To be
completed for UPMC account transfers:
Account #__________________________________
Administrator’s Name_________________________
Administrator’s Signature______________________
CISM: Advanced Group
Crisis Intervention (PN58)
OVERVIEW:
The Advanced Group Crisis
Intervention training program has been designed to provide participants with
the latest information on critical incident stress management techniques and
post-trauma syndromes. The program emphasizes a broadening of the knowledge
base concerning critical incident stress interventions as well as Post-
Traumatic Stress Disorder which was established in the basic program and/or in
publications. At the conclusion of this educational program the participants
will have been exposed to specific, proven strategies to intervene with those
suffering the ill effects of their exposure to trauma. The emphasis will be on
advanced defusings and debriefings in complex
situations.
EDUCATIONAL OBJECTIVES:
At the conclusion of this
program, participants should be able to:
·
Define
stress, stressors and excessive stress
·
List
at least three common mistakes in CISM
·
Identify
the role of CISD in the prevention of PTSD
·
List
the five most complicated CISM interventions
·
Discuss
ways to participate in complex debriefings
WHO SHOULD ATTEND:
The
Advanced Group Crisis Intervention training has been developed for EAP, human
resources and public safety personnel, mental health professionals, chaplains,
paramedics, firefighters, physicians, police officers, nurses, dispatchers,
airline personnel and disaster workers who are already trained in the critical
incident stress debriefing format. It will also be useful for those who are
working extensively with traumatized victims from various walks of life.
PRESENTERS:
Richard T. Boland, BS,
ICISF Trainer
Disaster Training
Specialist
University of
Robert Fonte, RN, MEd
ICISF Trainer
Program Director,
Crisis Training Institute
Office of Education
and Regional Programming
Western Psychiatric
Institute and Clinic
TUITION:
General
…….................................................$200.00
First Responders and Comprehensive Crisis Management Trainers
……………………. $175.00
Tuition
includes all registration and workshop materials; continental breakfast, lunch
and refreshments; in addition to continuing education credits. Full tuition
must accompany the registration form.
Please make checks out to WPIC/OERP.
A $15.00 administrative fee will
be deducted from any cancellation received less than two weeks before the
session. No refunds can be issued
once the program has begun. Please
mail completed registration form and payment to:
ATTN: Kyessa L. Brian
WPIC/OERP
4601
Telephone: 412-802-6905
Fax: 412-802-6910
Email: briankl@upmc.edu
http://www.wpic.pitt.edu/oerp
From
the East
Take the Parkway East (Route 376) to Exit 7 (Edgewood/Swissvale). At the end of
the exit ramp, turn right onto
To park at the
TO RECEIVE THE DISCOUNTED PARKING
RATE, PLEASE PARK IN THE
For
further directions and information on parking, please visit http://shadyside.upmc.com/Locations.htm or contact Kyessa L. Brian at 412-802-6905.
Social Workers: For social workers, 14.0 credit hours
of continuing education are provided through co-sponsorship of the University of
Pittsburgh School of Social Work, a PA-approved provider of social work
continuing education. These clock hours satisfy requirements for
LSW/LCSW, LPC and LMFT renewal. For information of social work
continuing education, call (412) 624-3711.
Educators (Act 48): Western Psychiatric Institute and
Clinic is recognized by the Pennsylvania Department of Education to offer
continuing education credits under Act 48 guidelines.
All Health Care Professionals: Other health care professionals are awarded 1.4 continuing
education units (CEUs).