First responders’ mental health grants

Name of project, amount funded and description

A Comprehensive Asynchronous Resiliency Training Program for EMS. Alberta Critical Incident Advisory Council ($168,105)

This project will develop, implement, and evaluate a resiliency training program for paramedic students, to mitigate Posttraumatic Stress Injuries (PTSI) in Alberta's EMS.

Course material, based on the Johns Hopkins model of resilience (or Psychological Body Armor), will be modified to add Canadian-specific content, culturally relevant information, and personal videos by paramedics describing their lived experiences.

Participants in this project will receive the training for free and it will include 12 to 14 hours of content asynchronously delivered.

The Working Mind First Responder. Alberta Municipal Health and Safety Association ($163,335)

This project will virtually deliver the Mental Health Commission of Canada’s program: The Working Mind First Responder (TWMFR), and provide access to Espri TELUS Health Mobile App, to upwards of 375 rural and remote fire service members.

Virtual training on TWMFR will include self-directed online “booster sessions”. The Espri TELUS Health Mobile App will provide participants access to: Evidence-informed PTSI content, TWMFR booster training, and behavioural activation tools that address first responder’s unique occupational challenges and risks for PTSI. The resources and content in the mobile app will reinforce training from TWMFR and help activate learnings to make self-care a regular part of work life, address operational stress injuries (OSI), clinically diagnosed PTSD, anxiety, and depression.

City of Lloydminster First Responder Peer-to-Peer Support. City of Lloydminster ($45,000)

This project will develop a peer-to-peer support program and subsequent program training designed specifically for Lloydminster first responders at risk of PTSI including the Fire Department, 911 Dispatch, and Peace Officers.

The goal for the peer-to-peer support program to create a strong, resilient network of first responders equipped to support one another and ensure team members dealing with or at risk of PTSI have the assistance to deal with those challenges.

Supporting Psychological Health in First Responders in Rural Communities. Town of Wainwright ($78,775)

The goal for this project is ‘building wellbeing and resiliency’ to mitigate the impacts of PTSI on First Responders throughout the East Central Region by creating an access point, along with training opportunities, for everyone to find means that will support their overall wellness in a sustainable manner.

Training will be offered to leaders, first responders, and family and friends, which will include Community Information Sessions, First Stage Training, Second Stage Training and Peer Support Group development.

The project will also train 2 Wellness Navigators in the First Responders Trauma Prevention and Recovery Certificate to provide further support to the region.

Name of project, amount funded and description

Work reintegration for trauma-affected healthcare providers and public safety personnel. Suzette Brémault-Phillips, University of Alberta ($210,285)

Public Safety Personnel (PSP) and Healthcare Providers (HCPs) work in demanding and unpredictable environments in which they are exposed to potentially psychologically traumatic events (PPTEs). Exposure to PPTEs can cause post-traumatic stress injuries (PTSI) that can compromise their capacity to work. In order to support the reintegration and return to work of police officers following exposure to a PPTE or after a long-term leave from work, the Edmonton Police Services (EPS) developed a reintegration program (RP). A step-by-step, member-driven, peer-supported return to work process, the RP facilitates relationship-building, reintroduction to equipment, skill-building, exposure therapy, and street exposures. Since its inception in 2009, the RP has supported 305+ EPS officers and RCMP, as well as 200+ AHS paramedics. Interest in the RP among PSP in other jurisdictions and HCPs (for example, nurses, physicians, respiratory therapists, and allied health professionals) has also been growing. Prior to the RP being further adapted and adopted for other PSP and HCPs with PTSIs, it is imperative that research be conducted to determine the core EPS RP’s effectiveness. This proposed quasi-experimental mixed-methods study will investigate the effectiveness of the foundational EPS RP at reducing mental health symptoms and improving return to work (RTW) outcomes among police officers. Adaptation and contextualization of the RP specifically for ICU and emergency room (ER) nurses will also be explored, with an eye toward conducting a follow up pilot study, and exploring its potential adaptation, contextualization and implementation on a provincial, national and international level with other HCPs and PSP.

Research questions:

• What is the effectiveness of the work reintegration program at:
  • enabling return to work of PTSI-affected police officers and increasing work self-efficacy and engagement?
  • affecting organizational mental health knowledge, stigma and workplace culture?
• How might the reintegration program be adapted/ contextualized for Intensive Care Unit and emergency room nurses?

Treatment of Post-traumatic Stress Injury in first responders using transcranial magnetic stimulation. Chantel Debert, University of Calgary ($309,826)

In Canada, the prevalence of post-traumatic stress injury (PTSI) is approximately 12%, but this number is substantially higher in first responders. Transcranial magnetic stimulation (TMS) is a safe and non-invasive neuromodulation technique that induces neuronal depolarization with the goal of improving neurological/psychiatric symptoms. The objective of this study is to determine whether first responders will have significant improvement in PTSI symptoms with TMS treatment compared to placebo. Exploratory objectives include evaluating quality of life, anxiety, depression, headache and biomarkers of brain chemistry post-treatment and to TMS-response. Fifty-six first responders with PTSI recruited from Alberta health services and community clinics will participate in a sham lead-in, randomized controlled clinical trial. Participants will be randomized to either treatment at the right dorsolateral prefrontal cortex or the dorsomedial prefrontal cortex. Demographic information and questionnaires evaluating PTSI (Clinician Administered PTSD Survey – DSM 5 (CAPS-5)), cognition (Repeatable battery of assessment of neuropsychological scale), depression, anxiety, headache, quality of life, and biomarkers of neurochemistry (serum brain derived neurotrophic factor and MR spectroscopy) will be completed pre-treatment, following one-week sham, 4-weeks post-treatment, and 1-month post-treatment (questionnaires only). TMS protocol consists of one-week sham lead-in and 4-weeks TMS (intensity 100-120% of resting motor threshold amplitude, 1500 pulses applied consistently with a frequency of 1 Hz). Primary outcome will be analyzed by a one-way repeated measures analysis of variance (RM-ANOVA) and Tukey’s range test for Post-hoc analysis. Outcomes from this study have the potential to provide a non-invasive and safe treatment option for first responders suffering with PTSI.

Research question:

• To determine whether first responders have significant improvement in PTSI symptoms with transcranial magnetic stimulation treatment compared to placebo.
• Secondary measures of quality of life, depression, anxiety, headache and physiological parameters of serum brain derived neurotrophic factor, and central neurochemistry will also be compared post-treatment.

Compromised Conscience: An exploration of moral injury in police officers and dispatchers in Alberta. David Malloy, Kings University College at Western University ($113,774)

Moral injury (MI) has become a construct of significant interest. Described as the psychological distress resulting when one is required to participate or witness what one believes to be wrong, MI can occur when police officers or dispatchers make decisions or take actions in the line of duty that conflict with their internalized morals, ethics, or values. Specific morally injurious events can include: failing to act; making an error that results in an unwanted outcome; sees peers and leaders act in an unethical or unjust manner; or exposure to wide scale human suffering.

While linked with trauma, MI extends beyond a fear-response and is instead based in spiritual, cognitive, emotional, or existential struggle resulting in a wide array of negative health and occupational outcomes. For example, morally injured persons are at increased risk of suffering from post traumatic stress injuries (for example, posttraumatic stress disorder, anxiety, depression) and occupational impairments such as burnout, absenteeism and leaving the profession.

The main objective of this study is to identify if Alberta’s police officers and dispatchers feel that MI is relevant to them and to identify factors related to MI in this group. This information will then inform psychoeducation designed to provide police and dispatchers with the tools necessary to identify MI and how to deal with the diverse, sometimes morally challenging scenarios that they may face in their professional practice that may lead to MI. Ultimately we intend this psychoeducation to promote resilience and help ameliorate MI and PTSIs.

Research questions:

• Do police officers and dispatchers identify with the construct of moral injury?
• What exposures to police officers and dispatchers feel may be morally injurious?
• Would psychoeducation on moral injury be beneficial to the police organization and workers’ mental health?
• What would be included in psychoeducation? What would be the best delivery method?

A view of moral injury: Examining the effect of moral complexities on PTSI & occupational impairment. David Malloy, Kings University College at Western University ($137,410)

First responders (FRs) (that is, emergency call-takers and dispatchers, correctional officers, firefighters, paramedics, police officers, sheriffs) are exposed daily to complex moral and ethical dilemmas often rooted in profound human suffering. The COVID-19 pandemic increased and heightened these exposures. Participating in or observing an event that conflicts with personal morals, ethics, or values can lead to the development of a moral injury (MI). MI extends beyond fear and is based in cognitive, emotional, or existential struggle resulting in feelings of severe shame, guilt, and anger. Morally injurious events for FRs can include, but are not limited to, an inability to prevent death/harm, societal problems (for example, acts of domestic violence, illicit drug overdoses, homelessness, etc.), betrayals, and limited operational resources.

The importance of MI in FRs psychological health and occupational impairment is high. Research has found that MI is highly associated with with posttraumatic stress injuries (for example, posttraumatic stress disorder (PTSD), major depressive disorder, generalized anxiety disorder) along with substance misuse, and suicide. MI has also been associated with significant occupational impairment including conflicts with authority, compassion fatigue, burnout, absenteeism, and even leaving the profession. In the current COVID-19 climate, limiting occupational impairment in FRs is paramount. This project aims to survey Alberta’s FRs to determine: (1) what events are seen as morally injurious within and between FR groups; (2) the prevalence of MI; and (3) associated psychological and occupational impairment. Knowledge gained from this study will inform the development of a moral resilience preparedness program for FRs.

Research questions:

• What type of events do first responders consider to be morally injurious?
• How are foundational constructs related to moral injury distributed among and between Alberta first responders?
• What is the relationship of moral injury on first responders’ psychological health and occupational impairment?
• Do symptoms related to moral injury differ between sex, gender, ethnicity and spirituality?

Immersive Virtual Reality for Self-Management of Post-Traumatic Stress Injuries in First Responders. Douglas Archibald, University of Ottawa ($277,636)

The COVID-19 pandemic has had a dramatic impact on first responders (FR) and emergency health care workers (EHCW). The constant threat of infection, the isolation from having to isolate from their own families, supporting patients at the lowest points, the high patient load, and the increasing death counts have resulted in a growing mental health crisis. Numerous studies have been conducted on the benefits of virtual reality exposure therapy (VRET) on the treatment of post-traumatic stress injury (PTSI), post-traumatic stress disorder (PTSD), and anxiety disorders. The intervention is to educate users by making them more aware of their PTSI to empower them in their own care and well-being. This study will adapt a scuba diving immersive virtual reality (VR) psychoeducational experience to provide FRs and EHCW with functional coping strategies for managing their PTSI during and post-COVID-19 crisis. This study will explore the impacts of using the immersive scuba VR experience to better engage FR and EHCW in deeper and active learning. The researchers will implement and test the immersive VR psychoeducational experience on FR and EHCW in Alberta and Ontario to understand the psychological support and benefits of this learning on PTSI in alleviating symptoms, thereby improving mental health outcomes.

Research questions:

• What is the efficacy of immersive virtual reality on first responders and emergency health care workers experiencing post-traumatic stress injury as a result of the COVID-19 pandemic?
• How can the application of immersive virtual reality be used to teach coping skills for the management of post-traumatic stress injury?

Name of project, amount funded and description

Delivering and evaluating an established model of peer support for Alberta's first responders. Alberta Critical Incident Provincial Network ($99,875)

Funding will support the training of up to 200 first responders to receive their ‘certified peer supporter’ designation. Once trained, the first responders will be able to support the in-house delivery of pre-incident resilience training, deliver individual and group crisis interventions based on the protocols of the model and educate on helping first responders access evidence-based formal mental health services when needed.

Alberta occupational awareness training for health care professionals: First responder trauma. Alberta Fire Fighters' Association ($134,662)

Funding will support cultural competency training of dedicated health care professionals who seek to provide care for first responders throughout Alberta. The additional training to those that provide care should result in better treatment outcomes for post-traumatic stress injuries at all stages of the psychological health continuum.

Edmonton Fire Rescue Services mental health app. Edmonton Fire Rescue Services ($40,000)

Funding will support the development of a mobile application tailored to the requirements of the personnel of Edmonton Fire Rescue Services to enhance help-seeking behaviours, increase accessibility to vetted and appropriate resources, and to increase the use of preventative strategies in an effort to reduce the likelihood of the development of a post-traumatic stress injury and/or disorder.

Mental health and resiliency training for first responders. Wellness Works Canada ($31,600)

Funding will support mental health and resiliency training for first responders in Edmonton and Calgary. The training will teach attendees to identify, respond and support themselves and colleagues who are at risk and/or experiencing signs or symptoms of post-traumatic stress injuries.

Name of project, amount funded and description

Helping prevent moral injury among long-term care workers: A mixed methods toolkit development study. Bonnie Lashewicz, University of Calgary ($209,525)

Long-term care (LTC) is at the centre of tragic outcomes of COVID-19 and LTC workers face pronounced risk for occupational stress related injuries including moral injury. Moral injury results from guilt and/or shame that accompanies knowing what is needed yet being unable to do what is needed due to constraints outside one’s control. Moral injury is being newly and necessarily used to understand occupational stress among health-care workers during COVID-19 because compared to individually focused concepts such as anxiety, moral injury locates the source of problems in the structures and processes in which individuals are immersed.

Research question: What is needed to support mental health and help prevent moral injury among LTC workers?

Objectives: 1) gather evidence about worker mental health needs and moral injury risks, 2) collect worker evaluations of a selection of mental health support/moral injury prevention tools, and 3) create and disseminate a mental health support/moral injury prevention toolkit contoured to the needs of LTC workers in pandemic conditions.

COVID-19 physical distancing, virtual delivery of trauma therapies to trauma-affected populations. Suzette Brémault-Phillips, University of Alberta ($206,137)

COVID-19 is taking a significant toll globally on the mental health (MH) of individuals and communities, all the while prompting a change in the way that MH services are delivered. While in-person service provision is the gold standard, physical distancing has forced the use of alternate forms of delivery. MH clinicians have shifted to remote-delivery of therapies for trauma-affected populations (TAPs) including public safety personnel, military members, veterans, and civilian frontline workers. TAPs require timely access to secure digital health (DH) therapies if they are to remain able to serve their communities.

This project will examine whether DH delivery of trauma therapies works as well as in-person therapy for TAPs and the impact DH has on MH clinicians and TAPs. There is also a need to evaluate evidence to guide policy, practice, privacy/security, and implementation. This study will explore whether DH is appropriate to deliver trauma therapies to TAPs. Based on study findings, the team, with its well-established local, provincial and national relationships with TAPs communities and MH providers, will provide recommendations regarding DH use to inform decision-making.

Development of online before operational stress (BOS) programs for public safety personnel and their families. Dr. Linda Duffett-Leger, University of Calgary ($201,614)

Public safety personnel (PSP) experience heightened operational stressors, including shift work, exposure to traumatic events, and threats to personal safety. Prevalence rates for post-traumatic stress injuries (PTSI) range from eight to 44%. Children and spouses living in PSP-connected families experience the effects of this operational stress and too often programs and supports available to PSP are either unavailable to or non-inclusive of family members. An interdisciplinary team of researchers (PI: Dr. Kelly Schwartz) was recently awarded a $1 million CIHR Team Grant to expand the BOS program, a group-based education, prevention, and intervention program designed to build the strength and resiliency of PSP members, by developing and implementing the Before Operational Stress-Family program (BOS-F).

The COVID-19 pandemic has placed unprecedented strain on PSP families already impacted by operational stressors and highlights the challenges of traditional clinic-based services. The aim of this project is to rapidly transition the CIHR funded in-person programs to virtual delivery.

Assessing post-traumatic stress injuries among correctional workers in Alberta. Dr. Rose Ricciardelli, Memorial University of Newfoundland ($187,966)

Increased attention is directed toward work-related PTSI among police, firefighters, paramedics and military personnel. However, little is known about PTSI and other occupational stress injuries among those employed in correctional services at the provincial and territorial level, particularly with consideration for how COVID-19 may contribute to the development of PTSI. Previous researchers suggest rates of mental disorders are high among correctional workers.

This project will look at how COVID-19 and the overall correctional work experience are impacting the mental health and well-being of correctional staff in order to design a strategy to meet their health needs and encourage posttraumatic growth. In conducting an in-depth survey of the PTSI of correctional workers in Alberta, as well as British Columbia, the Northwest Territories and Quebec for comparative purposes, the researchers will develop understanding of how job experiences relate to correctional worker PTSI. In the end, they hope to identify how to protect a correctional worker from developing PTSI and areas of personal/psychological growth that might arise from dealing with PTSI.

Evidence-informed workplace policies and practices for the prevention of PTSI work disability. Dr. Dwayne Van Eerd, Institute for Work & Health ($172,820)

The prevalence of PTSI among first responders is high and often leads to work disability. Recent studies have shown that organizational policies and practices have an important impact on PTSI, but the scientific evidence about the effectiveness of PTSI interventions is modest at best. Regardless of the state of the scientific evidence, first responder organizations must develop ways to protect workers. The researchers propose to gather and synthesize evidence about the prevention of PTSI work disability from the scientific evidence with current practices and experiences of first responder organizations in Alberta and internationally.

The researchers propose a 3-stage data collection approach: 1) an environmental scan of international first responder organizations, 2) a review of reviews of the scientific literature, and 3) collection of current PTSI work disability prevention policies, programs, and practice from Alberta first responders. This project will engage with Alberta first responder stakeholders to co-develop the resulting evidence summary. This will help to ensure the findings are relevant and increase the uptake of knowledge to improve PTSI work disability policies and practices in Alberta.

Text4PTSI: An E-mental health solution to prevent and manage PTSI among first responders in Alberta. Dr. Vincent Agyapong, University of Alberta ($150,000)

This project involves implementing and evaluating Text4PTSI, a novel digital health program that provides daily supportive, therapeutic and educational text messages to first responders experiencing PTSI. Text4PTSI may provide mental health support for PSP already receiving mental health care or on a waitlist, and those with symptoms but have not actively sought care. To subscribe to Text4PTSI, PSP can text “PTSI” to a short code number that does not collect identifying data.

Subscribers would then complete 4 validated online mental health assessments at enrollment, 6 weeks, 3 months and the 6-month program completion date. The researchers previously launched the Text4Hope program during the COVID-19 pandemic and found that after 6 weeks of enrollment, daily text messages significantly reduced suicidal ideation (16.9% vs. 26.6%), disturbed sleep (76.1% vs. 85.1%), moderate/high stress (78.8% vs. 88.0%), anxiety (31.4% vs. 46.5%), and depression (36.8% vs. 52.1%) when compared to a control population who had not yet received the daily text messages. Similarly, the researchers hope the Text4PTSI program will significantly reduce PTSI symptoms in PSP.

Identifying risk factors for developing post-traumatic stress injuries following musculoskeletal injury. Dr. Doug Gross, University of Alberta ($49,494)

Work-related accidents and events that are experienced by first responders and emergency health care workers often result in physical injuries to bones, muscles, and joints. Sometimes the traumatic accidents causing physical injuries also result in mental health injuries such as PTSI. Workers with both physical and mental health injuries are much less likely to recover (2 times less likely in Alberta PTSI rehabilitation programs).

This has important implications for first responders, who are frequently exposed to psychologically traumatic events in the workplace and are particularly susceptible to developing work-related PTSI. Early identification and treatment of PTSI in first responders experiencing physical injuries could help them recover faster. Using data from WCB-Alberta, the researchers will study risk factors for developing PTSI following physical injury. This research will help clinicians to assess and treat first responders who are at risk for complicated outcomes. This research will contribute information that is important to improving worker recovery after injury and help them successfully return to work.