Proposed changes to NFPA 1500 will establish guidelines for developing behavioral health assistance programs
By Chief Ronald J. Siarnicki

Following is the fourth in a series of seven articles that describe a new approach to mental and behavioral health in the fire service. Read the other articles:

• Keep Your Head in the Game
• Get the Help You Need After a Traumatic Event
• Understanding Psychological First Aid for First Responders

This article will focus on employee assistance programs mandated by NFPA 1500: Standard on Fire Department Occupational Safety and Health Program.

NFPA 1500: Standard on Fire Department Occupational Safety and Health Program mandates that every fire department make a “member assistance program” available for fire department personnel and their families. This important element of the standard has led to a substantial increase in access to basic counseling and other assistive services. For many departments, this represents the primary (and sometime the only) avenue for professional behavioral health care.

Employee assistance programs grew from employers’ early interest in reducing lost productivity due to alcoholism. Early approaches were often peer-driven, worker-to-worker models with underpinnings similar to self-help movements like Alcoholics Anonymous. Access to more professional intervention and resources became a central feature as these programs evolved, and their focus expanded to include a much wider range of problems. And now, a number of different configurations for delivering an almost endless variety of services have emerged. No two systems are likely to be quite the same, and no clear guideline could be identified for what services should be delivered and by what level of provider.

Professionals from the field pointed out that employee assistance programming was more a business model and marketing strategy than a distinct package of services with established standards of care. As such, a series of changes was recommended for the next revision of NFPA 1500 to establish clear guidance for fire departments in designing specifications for the professional services aspects of their behavioral health assistance programs. Central recommendations include:
1. The behavioral health assistance program shall hold the capability to provide basic counseling, crisis intervention assistance, and triage and assessment regarding, at a minimum, alcohol and substance abuse, stress and anxiety, simple depression, family and parenting issues, career adjustment and typical problems.

2. The behavioral health program shall, when clinically indicated, refer members or their families for appropriate clinical and specialty care from providers equipped to deliver evidence-based treatment that’s consistent with current best practices and standards of care as established by authoritative guidelines.

3. The fire department shall adopt and follow clear, written policies regarding alcoholism, substance abuse and other dysfunctions that may adversely affect performance and/or fitness for duty.

4. When fitness for duty is in question, such fitness should be evaluated and determined consistent with Section 10.7, Fitness for Duty Evaluations.

5. The fire department shall adopt and follow clear, written policies that are consistent with applicable statutes, regulations and standards respecting records, confidentiality, data gathering and reporting, protection and release of privileged information related to its behavioral health assistance program, identifying to whom and under what conditions information can be released and what use can be made of records for purposes of research, evaluation and quality assurance..

6. Member records maintained by the behavioral health assistance program shall not become a part of the member’s personnel file.

Two recommendations were also entered for wellness programming:
1. The wellness program shall have the capability to provide the fire department and its members with empirically supported health promotion activities related to identified risk factors for firefighter health and safety (e.g., cardiac risk reduction, smoking cessation, blood pressure regulation, strength and fitness training, nutrition, stress management).

2. The wellness program will stay abreast of evidence informed approaches to health and safety promotion, both within the fire service and in related enterprises, and work with the fire department to make new programs available when evidence demonstrates their merit effectiveness.

You can learn more about the recommended revisions and their history at www.everyonegoeshome.com. Additional features will be added to assist fire departments and member organizations in developing specifications and to provide support to providers seeking to better serve fire department personnel and their families.

Chief Ronald J. Siarnicki is the executive director of the National Fallen Firefighters Foundation.

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