Abstract
Peer support, as part of a recovery-oriented approach to treatment, is a valuable resource across various clinical and nonclinical populations. Specifically, in fire service, peer support may bridge the gap between firefighters' behavioral health needs and access to professional services. The current chapter summarizes the literature on peer support utility, presents data on barriers to treatment, and describes the roles clinicians can fill in partnering with fire service peer support to enhance the quality and reach of behavioral health services offered to fire service personnel. Finally, future research directions are outlined to continue the conversation about how to improve collaborations between peer supporters, clinicians, and others working to support the needs and strengths of firefighters.
TopIntroduction
Firefighters are tasked with preventing fires and preserving life and property. As such, they are required to be on the frontline of emergencies including, but not limited to: fires, multiple casualty events, natural disasters, and community traumas such as shootings, terrorist acts, and explosions. Firefighters may also be exposed to line of duty deaths, critical injuries, and suicides of fellow fire service members. These events have the potential to be traumatic for firefighters, and research demonstrates that repeated exposure to potentially traumatic events (PTEs) may have serious repercussions on firefighters’ behavioral and physical health (Byrne & Espnes, 2008; Corneil, Beaton, Murphy, Johnson, & Pike, 1999; Murphy, Beaton, Pike, & Johnson, 1999; Wu, Yin, Xu, & Zhao, 2011). Although many firefighters complete their employment without developing a behavioral or physical health disorder, prevalence rates of depression, PTSD, cancer, suicide and substance misuse are higher among firefighters compared to the general population (Carey, Al-Zaiti, Dean, Sessanna, & Finnell, 2011; Haddock, et al., 2012; Javidi & Yadollahie, 2012; NIMH, 2017; CDC, 2017; Dill & Loew, 2012).
Because of the pervasiveness of behavioral health issues within fire service, having access to resources such as Employee Assistance Programs (EAPs), Member Assistance Programs (MAPs), and professional behavioral health clinicians can be useful to firefighters. While many fire departments provide resources such as EAPs and MAPs, and some provide direct access to clinicians, various barriers may prevent firefighters from seeking treatment through these means (Halpern, Gurevich, Schwartz, & Brazeau, 2009). The overarching objective of this chapter is to highlight how peer supporters, in collaboration with behavioral health professionals, may help bridge the gaps between firefighters’ behavioral health needs and access to professional services. Towards this end, this chapter summarizes the literature on peer support utility, presents information on barriers to treatment, describes ways clinicians can effectively partner with fire service peer support to enhance the quality and reach of firefighter-focused behavioral health services, and outlines future research directions to continue improving collaborations between peer supporters, clinicians, and others working to support the needs and strengths of firefighters.
Key Terms in this Chapter
Evidence-Based Treatment (EBT): Treatment supported by peer-reviewed scientific evidence.
Member Assistance Program (MAP): Similar to EAPs, a resource provided to members giving them access to counseling and referral services to assist with problems they may be having which negatively impact job performance. The union or business pays for this service for its members. There is also a difference between governance and reporting structure between EAP and MAPs.
Employee Assistance Program (EAP): A workplace program designed to assist work organizations in addressing productivity issues and assist employee clients in identifying and resolving personal concerns, including, health, marital, family, financial, alcohol, drug, legal, emotional, stress, or other personal issues that may affect job performance. An individual’s employer typically pays for these services.
Cultural Competence: Knowledge, awareness, and skills related to working effectively with individuals of various cultures.
Cultural Awareness Training: A presentation informing clinicians about fire service culture, with the goal of equipping clinicians with working knowledge of duties of the job, common diagnoses, common treatments, and logistics when treating firefighters.
Negative Expectations of Treatment: The belief that treatment will have perceived lack of usefulness, poor anticipated follow-up by clinicians, and beliefs that family members or co-workers are better resources than professionals. Can be a barrier to treatment in fire service.
Recovery-Oriented Model: The belief that all individuals have the capability to recover and improve their quality of life.
Self-Stigma: Internalized stigma; an individual’s belief that their illness makes them weak and/or damaged, leading to diminished self-esteem.
International Association of Fire Fighters (IAFF): Union consisting of paid full-time firefighters and emergency medical services personnel in the United States and Canada.
Peer Support: A program of care in which an individual in recovery supports his or her peers in their recovery and relates to them either by mutual identification or shared responsibility.