Firefighters Helping Firefighters An Overview of Clackamas Fire District #1 s Peer Support Program

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1 Firefighters Helping Firefighters An Overview of Clackamas Fire District #1 s Peer Support Program 2014 Oregon Fire District Directors Association Fire Service Conference

2 Firefighters Helping Firefighters An Overview of Clackamas Fire District #1 s Peer Support Program Just Doing Their Jobs Hitting Close to Home 1

3 Firefighters Have a High Risk of Divorce Substance Abuse Problems Mental Health Issues Stress in the Fire Service The Most Stressful Jobs of Enlisted Military Personnel 2. Military General 3. Firefighter 4. Airline Pilot 5. Event Coordinator 6. Public Relations Executive 7. Corporate Executive 8. Newspaper Reporter 9. Police Officer 10. Taxi Driver Why are Firefighters #3? Personality Characteristics of Emergencies Characteristics of the Job Perception Shift Control Issues 2

4 Types of Stress General Stress Cumulative Stress Critical Incident Stress Normal response of normal people to abnormal event 85% of firefighters have experienced stress reactions after tough call(s) Types of Stress Delayed Stress Post Traumatic Stress 1-2% risk in general population 16-20% risk in Emergency Responders PTSD Warning Signs Dissociation Traumatic dreams Memory disturbances Self-medication Out of control anger, hostility, irritability Persistent depression Panic attacks Persistent/intrusive recollections Stress Response Fight or Flight Enhances ability to work under pressure Stress response usually self-regulating Adrenaline and Cortisol Curbs nonessential functions Problem when fails to turn off 3

5 Brain Becomes Conditioned Firefighters at Higher Risk Digestive issues (antacids) Muscle pain, stiffness and fatigue without injury Decreased immune system Chronic Stress and Disease Excessive stress = health problems Increased risk of Heart disease Sleep problems Digestive problems Depression Obesity Diabetes Memory impairment Worsening of skin conditions, such as eczema What is Peer Support? Confidential assistance and appropriate support resources to employees and family members when personal or professional issues negatively affect their work performance, family unit or self. 4

6 Why Peer Support? Oversight Committee Representatives from: Labor Management Line Firefighters Administration Wellness Chaplain Program Human Relations Committee Initial Selection Nominated by Peers Peers Volunteering 5

7 Nomination Survey ICISF Training CISM: Individual Crisis Intervention and Peer Support CISM: Group Crisis Intervention Peer Support = Counseling? Peers Mitigate Crisis Response Acknowledge Normalize Encouraging Effective Coping Mechanisms Assess Need for Follow Up 6

8 Interventions Individual On-Scene Support Defusing Formal Group Work (Debriefing) Follow-Up Handbook Peer Responsibilities Provide emotional support during and after times of personal or professional crisis Refer peers to appropriate outside resources, when necessary. Be available for follow-up support Maintain general records Agree to be contacted and, if practical, respond at any hour Abide by "Confidentiality Agreement" To successfully complete the 4 day ICIFS required trainings Attend one continuing education meeting per year (three is preferable) 7

9 Confidentiality- ORS Communication is privileged IF The communication occurs during a peer support counseling session (meaning both parties are aware that the Peer Supporter is acting in his/her capacity as a Peer Supporter) The communication is with a person who has been designated and trained as a Peer Supporter Confidentiality- ORS The Confidentiality Law does NOT apply to: Any threat of suicide or homicide made by a participant in a peer support counseling session, or any information conveyed in a peer support counseling session relating to a threat of suicide or homicide; Any information relating to abuse of children or of the elderly, or other information that is required to be reported by law; or Any admission of criminal conduct Confidentiality Agreement 8

10 Compensation Training Classes and Peer Support Meetings Replacement will be covered if it is a normal shift day Attendance will be volunteer time if it is not a normal work day Responding to a Call for Peer Support When responding to a call for Peer Support, Peer Supporters will be compensated from the time they are called until they are finished with the incident. Recordkeeping Adding Peers more trained 2013: 12 more trained (plus 4 Chaplains) We currently have 33 trained Peer Supporters Fire Chief 2 Battalion Chiefs 6 Officers 5 Apparatus Operators 8 Firefighters 2 Administrative Managers 4 Administrative Staff 2 Fire Prevention Staff 2 Volunteers 1 Liaison to Retiree s 9

11 Contacting Peers Types of Contact Anytime On-Scene Post-Incident NO SELF DISPATCH! Triggers Like beauty, it s in the eye of the beholder. Response to event- not event itself Individual Factors Personality Existing Conditions Coping Skills Support Systems 10

12 Pre-Incident Education Remind Signs/Symptoms Effective Coping Strategies Resources Available Recruit 1 st Week of Hire Annual by Peer Supporters Resources for Peers EAP Free 24-hour crisis assistance Confidential 4 visits per issue Legal and financial services Personal Advantage website Supervisor Consultations Offer CISD s Resources for Peers Chaplains Contracted Behavioral Health Specialist Other Fire Agencies 11

13 Resources for Peers Education NW Peer Support Conference Code 4 ICISF CFD Couple s Communication Classes Resources for Peers Web Based Internal D1net Oregon Peer Support IAFF NVFC Additional Help West Coast Trauma Retreat Addiction Treatment Centers Mental Fit for Duty Services 12

14 Keeping Peer Supporters Engaged Meetings- 3x s per Year Housekeeping Data Old and New Business Intervention Updates Continuing Education Support for Peer Supporters What makes a good peer supporter also makes them vulnerable. Evaluating Success- Data Documented Interventions 2010: : : : 257 EAP Year New Cases F2F Visits Top 3 Issues Couples/Relationship 2. Grief 3. Family/Parenting Couples/Relationship 2. Family Parenting 3. Grief Couples/Relationship 2. Family/Parenting 3. Depression Family/Parenting 2. Couple/Relationship 3. Stress-home Couple/Relationship 2. Depression 3. Financial Issues Couple/Relationship 2. Family/Parenting 3. Depression 13

15 Evaluating Success- Data Mental Health Assessment Evaluating Success- Data Mental Health Assessment Evaluating Success- In their words 14

16 Growing the Program Continue to add Peers Liaison to Injured/Ill Mini-Academy for EAP Providers Spouse Peer Supporters Peer Support- A Chief s Perspective Questions? 15

17 Contact Information Heather Goodrich Health & Wellness Manager Clackamas Fire District #1 (503) Fred Charlton Fire Chief Clackamas Fire District #1 (503)

18 Appendix A CLACKAMAS FIRE DISTRICT #1 PEER SUPPORTER CONFIDENTIALITY AGREEMENT I hereby acknowledge that in carrying out my role as a member of the Clackamas Fire District #1 Peer Support Program, I may become aware of confidential personal and/or medical information concerning members of Clackamas Fire District #1 and their families. I agree not to disclose such information to any person outside of the Peer Support Team. I have reviewed O.R.S and understand that the legal protection covering peer support communications does not apply to the following exceptions: 1. Any threat of suicide or homicide, or any information relating to a threat of suicide or homicide; 2. Any information relating to abuse of children or of the elderly, or other information that is required to be reported by law; 3. Any admission of criminal conduct. Disclosure of confidential peer support communications to any other party will not be provided without the expressed consent of the involved Clackamas Fire District #1 member or family member, except in cases involving the above exceptions. I understand that I am expected to notify the Wellness Manager of any peer support communications involving the above exceptions. I understand that violation of this agreement will subject me to removal from further participation in the Peer Support Program. Print Name Signature Date Wellness Manager Date 14

19 CLACKAMAS FIRE DISTRICT #1 PEER SUPPORT ACTIVITY LOG Name: Year: Intervention Jan Feb Mar Apr May Jun 1 1 Post Incident 1 1 Other 1 1 Follow Up Group Defusing (Total # people) Informal Group (Total # people) Formal Group Debriefing (Total # people) Follow Up Group (Total # people) Intervention July Aug Sept Oct Nov Dec 1 1 Post Incident 1 1 Other 1 1 Follow Up Group Defusing (Total # people) Informal Group (Total # people) Formal Group Debriefing (Total # people) Follow Up Group (Total # people)

20 Clackamas Fire District #1 Peer Support Program After a Critical Incident Below are some basic stress management principles that have been shown to help mitigate some of the reactions the body has to a critical incident. WITHIN THE FIRST HOURS periods of appropriate physical exercise, alternated with relaxation will alleviate some of the physical reactions. Eat nutritious foods: fresh fruits, vegetables, and a balanced diet (even if you don t feel like it). Moderate your intake of caffeine Avoid alcohol or other depressants Keep rested; remain on a schedule for sleep and other relaxing activities Structure your time, keep busy. Avoid changes in your daily routine Find a friend or support source to talk about the incident Do not make any significant life altering decisions for at least 30 days Try to find time, perhaps just an hour, to do something you enjoy Help your co-workers as much as possible by sharing feelings and checking out how they are doing. Don t try to fight reoccurring thoughts, dreams or flashbacks - they are normal and will decrease over time and become less painful If the symptoms of stress do not lessen, seek additional assistance Reprinted from Tri-County CISM Network 2000 and International Critical Incident Stress Foundation, Inc. 2001

21 Clackamas Fire District #1 Peer Support Program Common Immediate Stress Reactions Eighty-five percent of all people exposed to a critical incident may develop noticeable symptoms within 24 hours. Most of these will disappear within three weeks time. If symptoms worsen, or it they do not begin to dissipate after two weeks, additional intervention is recommended. TENSION: physical and emotional tension, muscle tremors or twitches, unable to sit still for any length of time. FATIGUE: decreased energy, ability to sleep, or a desire to sleep continuously. SLEEP DISTURBANCES: insomnia, bad dreams, nightmares, or waking up too early. DIET: change in eating or drinking habits. Increased or decreased intake. NAUSEA: queasiness, nausea, vomiting other gastrointestinal problems. RECURRING MEMORIES: thinking about the incident or some associated recurring memory. NEGATIVE FEELINGS: unpleasant feelings that may come without warning; profound sadness, helplessness, fear, anxiety, anger, rage, discouragement, frustration, sense of vulnerability, depression. SELF-BLAME: vague feeling of self-blame, fixed on some aspect of the event. INTERPERSONAL PROBLEMS: increased irritability, insensitivity, blaming others for your problems, wanting distance instead of closeness. Reprinted from Schoenfeldt & Associates, 6905 Totem Beach, Marysville, WA 98271, (360)

22 Peer Support Program Resources International Critical Incident Stress Foundation ICISF provides training for individuals interested in becoming a part of a crisis management team, or for an organization that is dedicated to helping individuals or groups recover from incidents Code 4 Provides affordable and quality training for public safety personnelspecifically crisis intervention training. Oregon Public Safety Peer Support This site serves as a resource for all public safety workers throughout the State of Oregon. Whether you are a police officer, firefighter, dispatcher, corrections deputy, jailer, state corrections officer, parole & probation officer, paramedic, chaplain, etc., if you are looking for stress management resources or support, this is a good place to start. National Volunteer Firefighter Council Behavioral Health News health news The National Volunteer Fire Council (NVFC) is the leading nonprofit membership association representing the interests of the volunteer fire, EMS, and rescue services. International Association of Firefighters IAFF Wellness Fitness Resource for Behavioral Health. NW Peer Support Conference The Northwest Peer Support Conference hosted by the Clackamas County Sheriff's Office is a bi annual training designed to educate members of publicsafety peer support teams in a variety of crisis related issues as well as providing guidance for those interested in starting a peer support team. National Fallen Firefighters Foundation Behavioral Health Initiatives. West Coast Trauma Retreat WCPR is a six day non profit residential program and offers a unique setting for treatment of first responders who have been involved in critical incidents that affect not only their ability to work, but also their personal and home lives. It is one of only two such programs in the country and has been in existence since The program is peer based and clinically guided.