Maintaining Posttrauma Programs
HEALTH AND SAFETY
How to keep your program effective after it’s up and running.
Last of a three-part series.
The purpose of this three-part series is to provide a practical guide for fire departments that are planning to implement critical incident stress/posttrauma programs. Part I, which appeared in August’s issue, reviewed basic concepts concerning duty-related trauma and guidelines for planning posttrauma programs. Part II, in the September issue, suggested methods of gaining support and implementing program components— training, peer support, debriefings, and posttrauma counseling. In this last installment, methods for maintaining posttrauma programs will be discussed.
ANY PROGRAM must be carefully nurtured if it’s to be as effective five years from now as it was at the start. Posttrauma programs in fire departments may be difficult to maintain for several reasons:
Personnel would rather not think about the possibility of experiencing duty-related trauma. The publicity needed to maintain the program may at the same time trigger memories of critical incidents that may have occurred and increase existing posttrauma psychological consequences;
In many cases, posttrauma programs may be idle for a period of time. While training of recruits and new personnel will continue, posttrauma responses may be infrequent;
Posttrauma programs are still somewhat controversial and may not enjoy 100% support within a department. Detractors may hurt the program over a period of time by talking it down or saying that it’s not needed;
The posttrauma program depends on relationships between management/administration, advisory council, mental health workers, peer supporters, and personnel. All must communicate effectively for the program to operate. There may be a tendency for these important contacts to diminish over time, in which case the program will suffer.
These elements work against the longterm maintenance of a posttrauma program. However, with creative planning and work, it’s possible to ensure that an effective posttrauma response will be available.
GUIDELINES FOR MAINTAINING POSTTRAUMA PROGRAMS
The quality of posttrauma services and the amount of its exposure to personnel will determine success or failure in maintaining the program.
An effective program helps keep itself alive. The first few times a peer supporter contacts a firefighter or a debriefing occurs, word spreads about the general experience (“It helped to talk about it” and the like.) Positive feedback will make personnel feel more comfortable and more willing to participate again.
It’s crucial to emphasize the importance of confidentiality. Nothing harms a posttrauma program more than when personal information is communicated to others. Confidentiality must not only be stressed to management and peer supporters, but to the debriefing participants as well. If information that was shared in private becomes known by others, the level of trust will he greatly reduced.
Exposure to the program must occur at all levels of the department. Some communication and training efforts should be specifically directed at upper-level officers, who will he playing an important role in referring firefighters to peer supporters and mental health professionals. Options for reaching supervisors include program updates at officers’ meetings and one-on-one discussions.
Efforts to reach other personnel are limited only by creativity. Some have placed articles in departmental newsletters or magazines, distributed posters to be placed on bulletin boards, and had peer supporters speak at staff meetings. One program created buttons that read, “CIS?—Ask Me.”
Not all publicity need be extremely serious. Using tasteful humor in posters or cartoons, for example, can be an effective reminder that duty-related trauma is a risk of the fire service. Be creative and have fun while promoting the program.
THE TRAINING COMPONENT
It’s important to ensure that all personnel receive the initial critical incident stress training; any recruits or newly hired individuals should participate as soon as possible. In this way, all members will be knowledgeable about the posttrauma program and the psychological results of trauma.
The training of new recruits is especially critical. Recruits tend to have a much lower threshold of trauma than veteran members, and they’re more vulnerable to posttrauma psychological consequences until they gain experience and coping skills. It’s a good idea to modify duty-related trauma training for new members and to have veterans talk about their experiences on the fireground.
Recruits represent the future of the fire service, and most will support the addition of psychological care made available by the department. Recruits who receive the training will come to consider posttrauma services as routine and be supportive of the program.
Peer supporters are the heart of any posttrauma program, so special efforts should be made to keep their enthusiasm high and improve their skills by offering additional training.
PERPETUATING PEER SUPPORT
Peer supporters are the heart of the posttrauma program. Special efforts should be made to maintain their enthusiasm and to improve their skills.
It’s not uncommon for peer supporters to request additional training after the posttrauma program is implemented. The most requested topics include practice sessions, where mental health professionals give feedback concerning their work; substance abuse: debriefing skills: and suicide prevention. The added training enhances skills and increases confidence. Contact with other peer supporters builds morale and gives them the opportunity to discuss their experiences.
Meetings should be routinely scheduled to discuss administrative aspects of the program, both good and bad. Mental health professionals should attend so that questions on specific responses can be discussed.
At least once each year, peer supporters should meet for their own debriefing—a time for debriefing the debriefer. When especially traumatic critical incidents occur, a debriefing should also be planned. Peer supporters may be more vulnerable to chronic stress when they spend time and energy on others.
New peer supporters will be required at regular intervals. Some departing peer supporters will retire, find new jobs, or tire of the responsibility. New peer supporters must be trained so that all shifts and functions are represented.
DEBRIEFINGS AND COUNSELING
The big hurdles in keeping the debriefing and counseling functions of a posttrauma program running well are maintaining the skills of the mental health professionals and their relationship with personnel.
Mental health workers can get rusty if their skills aren’t used. They’ll be working with people every day, but may only occasionally have contact with firefighters experiencing traumatic stress. In some departments, mental health professionals and peer supporters refine their skills by planning a mock debriefing; a feedback session afterward helps them to improve their skills.
It’s also important for department personnel to continue getting to know the mental health professionals. Where we provide posttrauma services to departments, we attend meetings, conferences, and social gatherings where we can informally meet with personnel. When in the area, we ll stop by departments to talk to personnel. They know that we’re concerned and interested in what’s happening in the departments, and that “shrinks are people, too.”
EVALUATING YOUR POSTTRAUMA PROGRAM
Posttrauma programs must be evaluated to ensure effectiveness and satisfaction among personnel. At regular intervals, personnel should be surveyed to determine the rate at which program services are being used, as well as their perception of peer supporters and mental health professionals. Informal discussions can help unearth problems in confidentiality and what’s being said in the rumor mill.
The perceptions of mental health personnel and peer supporters will also be useful. If possible, the mental health professionals should follow up with debriefing and counseling participation to monitor any longterm posttrauma consequences that may have developed.
Finally, compile a list of all incidents where responses have taken place. A determination can then be made about the appropriateness of a decision to provide posttrauma services. The evaluation’s results should be given to the advisor) council for any decisions on how to make the program better for the department.
In this series we’ve expressed our understanding of the issues regarding duty-related trauma as well as our experience in making posttrauma programs operate efficiently. It’s our hope that this will make it easier for all departments to protect their employees from the long-term psychological risks of the fire and emergency service.
