First responders’ mental health grants

Name of project, amount funded and description

Alberta Critical Incident Advisory Council: Delivering and evaluating CISM peer support training for first responders in Alberta ($99,375)

The project will provide training of the International Critical Incident Stress Foundation’s (ICISF) Critical Incident Stress Management (CISM) peer support training modules to 265 frontline first responders (FR) throughout Alberta. The ICISF CISM model of peer support is a best practice model of psychological resistance, resilience, and recovery (R3) delivered in-house by the first responders who participate.

Momentum Walk-In Counselling Society: Support group for first reponders and front line workers ($40,000)

The project aims to provide a series of drop-in psycho-educational support groups for 150 first responders, living with, or at risk of, post-traumatic stress injury (PTSI) as a result of working on the front lines of service delivery. First responders will have a safe, supportive environment to share their experiences and feelings.

Canadian Women’s Wellness Initiative: An innovative approach to stress reduction for Alberta’s first responders ($41,100)

This project will provide training and follow up in the transcendental meditation (TM) program for up to 40 first responders in Alberta who are living with PTSI. TM is a simple, easy-to-learn approach that relieves symptoms of stress, anxiety, depression, PTSI and develops greater resilience to stress. This is an effective stress reduction program with results often showing right from beginning of the practice.

Town of Wainwright: Supporting psychological health in first responders in rural communities (45,296.20)

This project aims to provide training to first responders, workplaces including their leaders and support staff, as well as families and friends including children of first responders in Wainwright and surrounding rural areas. The participants and their families will learn to reduce stigma and barriers to accessing support for trauma, mental wellness coping strategies, early recognition of PTSI, burnout and stress. A resource hub will be open to the public and accessible at no cost 24/7.

The Veteran Hunters of Canada: REBOOT Recovery – Overcoming trauma together ($45,480)

The REBOOT Recovery program to first responders will provide the practical tools and teaching for those within the law enforcement, fire, EMS, emergency communications, hospital emergency and corrections communities in a group therapy program format that features a combination of video teaching and facilitated discussion. The program will improve participants quality of life in the areas of anxiety, depression, fatigue, gratitude, self-efficacy, self-esteem and well-being, and this project aims to serve 144 first responders.

Town of Wembley: PTSI Workshop for first responders and their families ($5,200)

The proposed project will see the Wembley Volunteer Fire Department provide a single, full-day facilitated workshop to its firefighters and their families, which total about 30 beneficiaries. The workshop will support the psychological health of participants by familiarizing participants with the common symptoms of PTSI,  underscoring the dangers of leaving such symptoms untreated, and introducing resiliency strategies for better PTSI management.

Alberta Paramedic Association: PTSI workshop for first repsonders and their families (68,540)

This project will provide six half-day workshops for paramedics struggling with PTSI and their families.  Led by an experienced group facilitator from Wounded Warriors Canada, each workshop will impart tools and techniques for learning resiliency, adaptability, compassion, and empathy without losing a sense of individual or collective/familial identity to an expected audience of 180 beneficiaries.

Stoney Nakoda First Nation: Mental health resiliency for Stoney Nakoda EMS first responders ($75,083)

This project aims to provide mental health and wellness services for all EMS first responders to address stress, anxiety, trauma, grief, and PTSD/PTSI. Stoney Nakoda EMS want to incorporate activities and services that encompass the physical, emotional, mental and spiritual aspect of wellness. Land base opportunities (sweats, picking sage/sweetgrass), smudging, inter-connected activities, water-based activities, meditation, all with an aim to assist all 70 EMS first responders.

Town of Whitecourt: Arming first responders with protection against psychological injury ($25,250)

The project aims to 1) develop post incident protocols and critical incident stress management guidelines, as well as adopt and implement peer support guidelines and resources, 2) provide training to firefighters and their families on psychological health resiliency, and 3) host one-day regional workshops for first reponders to bring awareness of PTSI to small rural communities. The total beneficiaries expected are 75 people directly and many others indirectly through the project outcomes implementation.

Elk Point Firefighters Association: PTSI workshop for first responders and their families ($13,625)

The proposed project will see the Elk Point Firefighters Association provide a series of three  facilitated workshops to volunteer fire departments and their families, totalling an expected audience of 150 beneficiaries. The workshops will support the psychological health of participants by familiarizing participants with the common symptoms of PTSI, underscoring the dangers of leaving such symptoms untreated, and introducing resiliency strategies for better PTSI management.

Boots on the Ground Peer Support for First Responders – Alberta Division ($26,220)

This project aims to create a peer-support help line for all active and retired first responders in Alberta through volunteer training and marketing efforts. This program seeks to help to break down the stigma surrounding mental health among this population and allow these individuals to seek the appropriate support and care they need. The Boots on the Ground peer support lines are staffed by volunteers who also belong to the first responder communities and have an understanding of the challenges faced within these professions.

Regional EMS Foundation: Lending libraries ($10,000)

The lending library project is an initiative designed to provide access to books and resources for EMS professionals who may not have the means or ability to purchase them. The project involves setting up lending libraries in various EMS stations, where professionals can borrow books and other educational resources free of charge. The lending library project aims to promote literacy and education among the local 200 EMS professionals by making these resources accessible to everyone, regardless of their socio-economic status or geographic location. Additionally, the project also helps to reduce waste and promote sustainability.

Wounded Warriors Canada: Wounded Warriors Canada Trauma Resiliency Program (TRP) ($41,303)

This project provides access to six to eight first responders to the TRP group counselling program that has been established as an effective means to helping individuals who are suitable for a group experience to receive support from fellow group members, receive training and education and practice new skills. Both TRP1 and TRP2 follow best practices for all group counselling.

Name of project, amount funded and description

Colleen Grady (Queens University): Exploring onboarding practices for PTSI prevention in entry to practice paramedics ($109,682)

Paramedics are at increased risk of exposure to traumatic events compared to the general public and as a result, are at increased risk of developing operational stress injuries, including post-traumatic stress injury (PTSI). Organizational socialization for new employees, referred to as onboarding, allows new recruits to acquire the necessary knowledge, skills, and time to be oriented in their new role and within the organizational culture. In the case of new career paramedics, early intervention and prevention practices which are introduced during the onboarding process and prior to stress exposure, could significantly reduce the burden of PTSI for paramedics in Alberta and beyond.

In this exploratory study, our interdisciplinary team will seek to better understand the scope of the situation in relation to prevention of PTSI in early career paramedics and will do this by reviewing the literature for current practice, and through a national survey, semi-structured interviews, and focus groups with practicing paramedics to gain their perspective on mental health prevention. Working closely with the Paramedic Association of Canada, our team will invite participation from paramedics across the country, working through associations and organizations that support them in their roles.

Results from this study can have far-reaching benefits to front-line paramedics to enable improved prevention strategies which can be incorporated into early career development and to those organizations and associations that have the capacity to enact policy change and practice change at the provincial/territorial levels.

Marcella Siqueira-Cassiano (University of Winnipeg): Occupational stressors among public safety communicators in Alberta ($149,103)

Public safety work in Canada and abroad is marked by a high incidence of mental health disorders. Public safety communicators, including those working in emergency dispatch, screen positive for PTSIs such as major depressive disorder, general anxiety disorder, post-traumatic stress disorder, and suicide ideation at a higher prevalence than the general population (Koopmans et al. 2017; Klimley et al. 2018; Regehr et al. 2013).

Although scholars and practitioners have a general understanding of the stressors affecting public safety personnel, more research is necessary to understand the specificities and micro dynamics underpinning stressors in each public safety occupation. This project will identify and analyze the stressors underpinning the occupational life of those working in emergency dispatch as public safety communicators (henceforth “PSCs”), such as dispatchers, call takers, and 911 operators.

This project has three objectives. First, understand occupational stressors associated with PTSIs and inform strategies and services for early intervention and prevention of mental health disorders among PSCs. Second, produce knowledge that can improve emergency communication curriculum and training (i.e., MacEwan University’s program and other programs in Canada), especially regarding early-career PSCs’ readiness to experience and cope with frequent exposure to occupational stressors and psychologically traumatic events (PPTE), as well as manage the development of PTSIs. Third, advance the scholarship on health determinants in the public safety sector.

Gaang Lee (University of Alberta): A wristband-based daily monitoring of post-traumatic stress injury risk for preventive interventions ($98,448)

Preventive interventions have recently emerged to mitigate the impact of PTSIs on first responders’ work and personal lives and to safeguard their well-being. Identifying individuals at high risk of developing PTSIs before they occur is essential for implementing preventive interventions. However, current manual techniques such as behavioral observations, questionnaires, and interviews are impractical for widespread implementation. Consequently, we frequently find ourselves missing the optimal window for preventive interventions for individuals at high risk of PTSD, leading us to heavily rely on reactive care.

To address this issue, this project aims to develop and test a scalable technique that monitors PTSI risks (or precursors) in first responders' daily work with an affordable and non-invasive wristband biosensor. To evaluate the effectiveness of the proposed technique, a field test will be conducted with 100 firefighters during their daily work. We will monitor their PTSI risk for one month following a potential traumatic event and predict the subsequent development of PTSI based on this monitoring. The accuracy of the technique-based PTSI prediction will be assessed by observing the firefighters' subsequent PTSI symptoms within a three-month period.

If successful, the proposed monitoring technique can be widely implemented in the daily work of first responders, enabling the timely identification of individuals at high risk of developing PTSIs. This, in turn, will facilitate the implementation of preventive interventions, ultimately leading to a significant reduction in the occurrence of detrimental PTSI symptoms among first responders.

Suzette Brémault-Phillips (University of Alberta) Workplace reintegration initiatives for public safety personnel in Alberta ($195,411)

Public safety personnel (PSP) work in demanding and unpredictable environments in which they are exposed to potentially psychologically traumatic events (PPTEs). Exposure to PPTEs can cause PTSIs that can be debilitating across many domains including physical and mental health, interpersonal functioning and capacity to function professionally and meet the demands of the workplace.

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 thousands of PSP in Canada, New Zealand, and the United States. Interest in the RP among PSP in other jurisdictions and healthcare professionals (e.g., nurses, physicians, respiratory therapists, and allied health professionals) has also been growing.

Prior to the RP being further adapted and adopted for other PSPs 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 set the stage for development and trial of a standardized RP facilitator training curriculum, and nationwide RP community of practice. It will also allow capture of evidence regarding the effectiveness of the foundational EPS RP and up-down exercise at reducing mental health symptoms and improving return to work outcomes among PSPs with PTSIs.

Linda Duffet-Leger (University of Calgary) Development and pilot testing of an intelligent online psychoeducational support program (SENSE) ($217,394)

Problem: Emergency health care workers, such as nurses and social workers, are regularly exposed to diverse PPTEs. Cumulative exposure to PPTEs can lead to mental health problems reflected in higher rates for nurses and social workers, 47.9% and 33% respectively, than for the general population. The COVID-19 pandemic has placed unprecedented strain on Canadian nurses and social workers putting them at increased risk for traumatization and subsequent psychological disorders such as PTSD and moral injury contributing to the current health human resource crisis in Alberta. There is a notable lack of effective mental health support programs tailored to the specific needs of nurses and social workers.

Proposed solution: To address this critical gap, our interdisciplinary team of researchers (nursing, social work, engineering and kinesiology) will develop and pilot test the Supporting Emotional Wellness in Nurses and Social workers E-mental health (SENSE) program. Based on our pilot research, this novel intervention will be co-designed with nurses and social workers, and combine virtual group cognitive behavioral therapy with real-time feedback from an artificial intelligence enabled stress assessment tool. The pairing of wearable technology will provide users real-time feedback in their daily context, thus helping them to develop the skills needed for optimal mental health management. SENSE promises to foster the well-being of emergency healthcare workers, promote retention of these vital frontline workers in Alberta, and improve access to innovative mental health services.

Rose Ricciardelli (Memorial University of Newfoundland) Understanding the impacts of emergency response team membership: Trauma, wellness, and ways forward ($193,490)

Increased attention has been directed towards tactical police officers and emergency response teams (ERT), mainly as the tool employed by police services to manage and respond to the most severe and dangerous calls for service. For example, hostage situations, barricaded persons, domestic terrorism, and sniper situations. Generally, public safety personnel (PSP), like police officers, are more likely to be exposed to PPTEs in comparison to members of the general public, which ensues a higher probability of developing a mental health disorder, such as PTSD, major depressive disorder, and general anxiety disorder.

The extent of how ERT experience informs the team members mental health has yet to be investigated, qualitatively or quantitatively. However, given exposure to PPTEs is inherent to policing, we anticipate PPTE exposure more broadly is an expectation of tactical policing. Recognizing this, we focus in the current study the occupational stress and PTSI of tactical police officers in Canada, with a particular focus on the six ERT teams in Alberta, with comparisons to at least one service in each other Canadian province and territory.

Our study is qualitative, where we will build on prior survey work that details the composition and recruitment processes for ERT, to understand how ERT members' mental health is shaped by their occupational role. Outcomes will focus on recommendations tied to ERT needs and specialized training as well as access to treatment and other services.

Name of project, amount funded and description

Alberta Critical Incident Advisory Council: Delivering and evaluating CISM peer support training for first responders in Alberta ($99,875)

Funding will support the training of up to 120 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 Municipal Health and Safety Association: First responder and family PTSI ($382,750)

This project will expand on an awarded SPHIFR 2021-22 grant and will deliver the Mental Health Commission of Canada’s program: The Working Mind First Responder, and provide access to Espri TELUS Health Mobile App, to upwards of 750 rural first responders, and their families.

City of St. Albert: Personal protective app ($75,000)

Funding will support the development of a customized mobile application tailored to the requirements of the personnel of the City of St Albert’s first responders, dispatchers, and emergency health care workers.

Bearspaw First Nation: Stoney Trail Wellness Center Post-traumatic stress injury prevention program ($120,400)

This project will support the Community Emergency Response Team through the contracting of a psychiatric nurse specialized in PTSI prevention who will develop policies and protocols aimed at the reduction of PTSI related symptoms.

Town of Whitecourt: PTSI organizational impact evaluation and implementation of a resource guide ($17,000)

The Town of Whitecourt will use the funding to complete an organizational assessment of available PTSI supports for the Whitecourt fire department and develop recommendations for the prevention of PTSI. Deliverables will include a resource guide with industry approved best practices to help identify risks, challenges, and implementation strategies.

Name of project, amount funded and description

Chen (University of Alberta): Development of a mobile app for detection of PTSI in first responders ($200,000) 

Alberta’s first responders, including firefighters, police officers, paramedics, sheriffs, correctional peace officers, and emergency healthcare workers, have a high risk of developing post-traumatic stress injuries (PTSI) due to the exposure to the stressful and dangerous working environment. Early detection of psychological stress is critical for PTSI prevention and intervention.

This proposal aims to develop a cloud platform, including mobile applications and web servers, for PTSI screening. This cloud platform will use prosodic, semantic, and facial micromotion features to assess the mental health conditions of first responders. This next-generation mental health platform will help with the early detection of PTSI symptoms and trigger clinical intervention if necessary.

A combination of advanced artificial intelligence (AI) and machine learning (ML) technologies and algorithms will be used to identify facial and audio trends from volunteer first responders to identify critical features related to PTSI. This project builds off the highly successful work in Dr. Chen’s laboratory in developing a speech and text model for depression predictions.

After this AI-based technology is validated, we will migrate the system to a mobile application that will be user-friendly and provide a novel mechanism for first responders to monitor PTSI from anywhere.

Drolet (University of Calgary): Supporting equitable, diverse, and inclusive psychosocial health and resilience of first responders in Alberta ($51,875)

Firefighting is a dangerous occupation with a high incidence of stress-related injuries including post-traumatic stress injuries (PTSI). Most studies focus on physical injuries with limited literature on the role of social supports for firefighter’s psychosocial health and strengthening resilience. Social supports are critical to the mental health of firefighters.

In partnership with the Canadian Mental Health Association (CMHA), Alberta Division, and the Alberta Professional Firefighters and Paramedics Association (APFFPA), this study integrates Equity, Diversity, and Inclusion (EDI) in the research design to consider the perspectives of firefighters and community leaders, the provision and perception of social supports, and how to enhance recruitment and retention of firefighters who are characterized as diverse and have intersecting identities as they tend to make up a small percentage of the firefighters in Alberta.

Developed by CMHA and experienced firefighters, the Resilient Minds™ (RM) Building the Psychological Strength of Firefighters is an evidence-based, trauma-informed, peer-to-peer training program designed to enhance the personal resilience of firefighters and the collective resilience of fire services. The RM program is facilitated by firefighters to firefighters but currently, there are few resources available for those providing social supports for firefighters.

The research results will inform the development of new resources including an open access toolkit and adapted versions of RM training for diverse social supports and first responders to facilitate collaboration across stakeholders to enhance policies and practices to prevent and treat PTSI of firefighters.

Gross (University of Alberta):  Effectiveness of telerehabilitation during the pandemic for workers with post-traumatic stress injuries ($157,266)

The purpose of this study is to improve the treatment, rehabilitation, and return-to-work (RTW) outcomes of injured workers, including first responders, undergoing rehabilitation for post-traumatic stress injury (PTSI). We previously studied characteristics and RTW outcomes of first responders with PTSI undergoing in-person rehabilitation. Outcomes in this population are much worse than among workers with other occupational injuries, with a minority (43.5%) returning to pre-accident work after PTSI rehabilitation. Improved rehabilitation strategies are desperately needed.

Telerehabilitation presents a novel strategy that may improve access, engagement, and effectiveness of PTSI rehabilitation. Telerehabilitation was a valuable method of rehabilitation service delivery during the COVID-19 pandemic and continues to be used in certain contexts. However, research is needed to determine its effectiveness and safety among first responders with PTSI.

Thus, we will conduct a multiple methods study to evaluate the pragmatic, “real-life” effectiveness of telerehabilitation among Albertan first responders and other workers living with PTSI. A quasi-experimental study using workers' compensation data will allow us to quantify the effect of telerehabilitation on RTW, while a qualitative interpretive description will allow us to learn the lived experiences and perceived safety of telerehabilitation in first responders with PTSI. The expected outcome is improved understanding of the effectiveness and safety of telerehabilitation for first responders and other workers living with PTSI.

Findings will inform evidence-based practice and policy decisions regarding telerehabilitation. Beyond practical implications for Albertan first responders, results will have important implications as one of the first large-scale pragmatic evaluations of telerehabilitation for workers with PTSI.

Huey (University of Western Ontario): Occupational stressors associated with policing highly contentious mass-protest events ($120,109)

For the first time since the 1930s, Canadians witnessed a series of mass protest events across the nation in response to provincial and federal COVID-19 vaccine and mask mandates. These events led to significant strife among citizens and, combined with the effects of the pandemic on local police services, created new pressures on police agencies. Focusing on the recent "Freedom convoy" protests in Alberta, this study examines psychological stressors experienced by individual officers involved in the policing of such events, and identifies those factors unique to protest policing that can lead to operational stress injuries (OSIs) among patrol, public order, special units and E-comm personnel (those responding to 9-1-1 calls).

The overarching goal of this project is to generate a new body of research that will help us to better recognize the impacts of public order policing on officers and to improve upon identifying, reducing, eliminating and / or more effectively responding to occupational and organizational stressors resulting from these events that can lead to OSIs.

Thus, we intend to produce methodologically sound research that can be used to inform future education, training, policy and practice in this area. This study will be the first of its kind in Canada, and will contribute significantly to what has largely been a nascent body of research globally in relation to public order policing.

Jin (University of Calgary): Post-traumatic stress injury among Black, Indigenous, and People of Colour first responders ($132,400)

First responders are at high risk for post-traumatic stress injury (PTSI), including symptoms of post-traumatic stress disorder, depression, and anxiety due to occupational traumas (44.5% of general first responders). Additionally, Black, Indigenous, People of Colour (BIPOC) first responders, including those residing in Alberta, report racial trauma caused by direct encounters of race-based discrimination and / or historical and intergenerational trauma.

Critically, experiences of traumas exacerbate PTSI, yet none of the existing evidence-based PTSI treatments are tailored to BIPOC first responders. The proposed study addresses this dearth of PTSI epidemiological and intervention research among BIPOC first responders in Alberta. Our study will help understanding of traumas among BIPOC first responders, identifying underlying emotional and interpersonal processes, informing PTSI treatment to target emotional and interpersonal factors, and promoting PTSI awareness through highlighting equity, diversity, and inclusion among BIPOC first responders.

Aims include to:

1. examine prevalence of racial traumas and occupational / non-occupational traumas
2. examine relations between traumas (racial, occupational, non-occupational) and PTSI
3. examine the mediating roles of emotional and interpersonal processes in the associations between traumas and PTSI
4. provide deliverables

In Phase I, the project will recruit 200 eligible BIPOC first responders in Alberta to examine Aims 1 to 3. Data will be analyzed using frequency, multivariate multiple regression in SPSS software, and path analyses in Mplus software.

In Phase II of our Community-Based Participatory Research, we will provide deliverables (for example: workshops, skill toolkit) to community partners and stakeholders drawing from study findings and evidence-based PTSI treatment such as Dialectical Behavioural Therapy.

Van Eerd (Institute for Work & Health): Implementation of PTSI programs in Alberta first responder organizations. ($153,226)

The prevalence of post-traumatic stress injury (PTSI) among first responders is high and often leads to work disability. Studies have shown that organizational policies and practices have an important impact on PTSI. Our ongoing research revealed Alberta first responder workplaces are developing PTSI policies and programs. However, preliminary findings also show there are challenges to program implementation, particularly among smaller services/communities.

Our objective in the proposed research is to examine current implementation approaches as well as key facilitators and challenges in Alberta first responder organizations. A secondary objective is to co-develop a practical implementation approach for use by first responder organizations to initiate or complete implementation of PTSI policies and programs. Through our earlier work, we have established a strong stakeholder network and propose to work with them in the current study about implementation steps for PTSI policies and programs.

We propose a 2-stage project:

1. conduct interviews with key informants (n=20) from Alberta first responder organizations asking about implementation of PTSI policies and programs including barriers and facilitators
2. conduct workshops to co-develop a practical implementation approach for PTSI policies and programs with Alberta first responders

We propose 3 workshops with approximately 15 to 20 participants in each from urban and rural areas. The interviews and workshops will be recorded, and the data will be analyzed qualitatively to determine key implementation themes. Working closely with Alberta stakeholders will help ensure the findings are relevant and increase the uptake of knowledge to improve implementation of PTSI policies and programs in Alberta.

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.