ACIPN CISM Utilization Evaluation Form 2023 Question Title * 1. In 2023, how often did you attend CISM Team meetings? 5 times 4 times 3 times 2 times 1 time Never If more than 5 times, please specify in numbers: Question Title * 2. If you attended CISM Team meetings in 2023 did your team practice peer support skills regularly? Yes No I did not attend CISM Team meetings in 2023 Question Title * 3. Please describe any barriers that prevented you from attending CISM Team meetings in 2023: Question Title * 4. In 2023, how often did you and/or your CISM Team present the Pre-Incident Education slides to your department? 5 times 4 times 3 times 2 times 1 time Never If more than 5 times, please specify in numbers: Question Title * 5. Please describe any barriers that prevented you and/or your CISM Team from facilitating Pre-Incident Education in 2023: Question Title * 6. In 2023, how many informal peer support interactions did you engage in? (i.e., check-ins, peer support conversations, handing out brochures, etc.) 5 times 4 times 3 times 2 times 1 time Never If more than 5 times, please specify in numbers: Question Title * 7. In 2023, how often did you provide individual (one-on-one) crisis intervention (SAFER-R)? 5 times 4 times 3 times 2 times 1 time Never If more than 5 times, please specify in numbers: Question Title * 8. In 2023, how often did you refer a person you were supporting to the next-level-of-care, such as to a mental health professional? 5 times 4 times 3 times 2 times 1 time Never If more than 5 times, please specify in numbers: Question Title * 9. In 2023, how often did you use the CCDR model for Suicide Response, facilitate a suicide intervention or support a person experiencing suicide ideation? 5 times 4 times 3 times 2 times 1 time Never If more than 5 times, please specify in numbers: Question Title * 10. In 2023, if you provided peer support, did you use assessment strategies and the 5T's formula to develop a Strategic Plan? Yes No I did not provide support in 2023 I only provided individual support that didn't require strategic planning. Question Title * 11. If you provide peer support in 2023, did you consult with any of the following anytime before, during or after the activation? CISM Team Lead ACIPN Clinical Director ACIPN Network Coordinator Another ICISF trained peer Another Mental Health Professional not trained in CISM Leadership Did not consult with anyone I did not provide support in 2023 If you consulted with more than one option please list them here: Question Title * 12. How would you rate the responsiveness of the consultation you sought? Extremely responsive Very responsive Somewhat responsive Not so responsive Not at all responsive I did not seek consultation I did not provide support in 2023 Question Title * 13. How would you rate the effectiveness of that consultation? Extremely effective Very effective Somewhat effective Not so effective Not at all effective I did not seek consultation. I did not provide support in 2023 Question Title * 14. In 2023, how often did you facilitate a Rest, Information and Transition Services (RITS)? 5 times 4 times 3 times 2 times 1 time Never If more than 5 times, please specify using numbers: Question Title * 15. In 2023, how often did you facilitate a Crisis Management Briefing (CMB)? 5 times 4 times 3 times 2 times 1 time Never If more than 5 times, please specify in numbers: Question Title * 16. In 2023, how often did you facilitate a Defusing? 5 times 4 times 3 times 2 times 1 time Never If more than 5 times please specify in numbers: Question Title * 17. In 2023, how often did you facilitate a Critical Incident Stress Debriefing (CISD)? 5 times 4 times 3 times 2 times 1 time Never If more than 5 times, please specify in numbers: Question Title * 18. If you facilitated a CISD in 2023, was a CISM-trained mental health professional present? Yes No I did not facilitate a CISD in 2023 Question Title * 19. How would you rate the outcome of your support in 2023 on average? Very positive Positive Neutral Negative Very negative I did not provide support in 2023 Question Title * 20. In 2023, were you activated to provide peer support through the ACIPN IamResponding app? Yes No Question Title * 21. If activated through the ACIPN IamResponding app, how did you find the initial process? Very easy Easy Neither easy nor difficult Difficult Very difficult I was not activated through ACIPN IamResponding app in 2023 Question Title * 22. How familiar are you with the ACIPN IamResponding activation algorithm? Extremely familiar Very familiar Somewhat familiar Not so familiar Not at all familiar Question Title * 23. In 2023, did you attend ACIPN's synchronous (online) CISM refresher training? Yes No Question Title * 24. Did the synchronous refresher training meet your expectations? Exceeded expectations Met expectations Below expectations Did not attend Question Title * 25. How effective was the synchronous refresher training you attended? Extremely effective Very effective Somewhat effective Not so effective Not at all effective Did not attend Question Title * 26. How would you rate your confidence in providing effective peer support BEFORE attending synchronous refresher training? (Please skip if you did not attend synchronous refreshers). 0 (Not at All Confident) 50 (Somewhat Confident) 100 (Extremely Confident) Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 27. How would you rate your confidence in providing effective peer support AFTER attending synchronous refresher training? (Please skip if you did not attend synchronous refreshers). 0 (Not at All Confident) 50 (Somewhat Confident) 100 (Extremely Confident) Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 28. Did the synchronous refresher schedule adequately accommodate your availability? Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 29. What aspect of the synchronous refresher sessions do you find most beneficial for you as a peer? Review of CISM concepts and theory Observe demonstrations of intervention role-plays Practice intervention role-plays Network with other ACIPN Peers Discussions Did not attend Other (please specify) Question Title * 30. Please share any comments you think could improve the synchronous refresher training experience. Question Title * 31. In 2023, did you attend in-person CISM refresher training through ACIPN? Yes No Question Title * 32. Did the in-person refresher training meet your expectations? Exceeded expectations Met expectations Below expectations Did not attend Question Title * 33. How effective was the in-person refresher session you attended? Extremely effective Very effective Somewhat effective Not so effective Not at all effective Did not attend Question Title * 34. How would you rate your confidence in providing effective peer support BEFORE attending in-person refresher training? (Please skip this question if you did not attend). 0 (Not at All Confident) 50 (Somewhat Confident) 100 (Extremely Confident) Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 35. How would you rate your confidence in providing effective peer support AFTER attending in-person refresher training? (Please skip this question if you did not attend). 0 (Not at All Confident) 50 (Somewhat Confident) 100 (Extremely Confident) Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 36. How would you rate your current confidence in providing effective peer support? 0 (Not at All Confident) 50 (Somewhat Confident) 100 (Extremely Confident) Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 37. How would you rate your current level of preparedness to provide peer support? 0 (Not at All Prepared) 50 (Somewhat Prepared) 100 (Extremely Prepared) Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 38. Can you access all the materials you need to provide effective peer support? Yes No Question Title * 39. If you couldn't attend CISM refresher training through ACIPN in 2023, please list the main barriers to your attendance. If you did attend refresher training, please list any barriers that interfere with your attendance. Question Title * 40. Do you have a coping plan to manage potential residual effects associated with being a supporter, such as secondary traumatic stress, cumulative stress and compassion fatigue? Yes No Question Title * 41. Do you know what your own supports are and how to access them? Yes No Question Title * 42. How much do you agree with the statement, "CISM Training and becoming a peer has increased my own resilience." Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Question Title * 43. Are there any barriers you can identify in yourself or your organization to providing effective peer support: Question Title * 44. How much does your leadership support your integrated CISM Team? A great deal A lot A moderate amount A little None at all Question Title * 45. Have you updated your ACIPN and IamResponding Profiles in the last 3 months? Yes No Are there updates that need to be made to either profile? Question Title * 46. 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