Working on Peer Support Programs
Initiative #13 working group works to develop easily accessible and inexpensive ways to identify best practices for peer support groups
By Chief Ronald J. Siarnicki

Following is the fifth 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
• Check Out What’s on the Horizon for Employee Assistance Programs

Chiefs can change the rules, but only peers can change the culture. That simple truism set the tone for an Initiative 13 working group at an event in Baltimore in August 2009. Representatives from critical fire service constituency organizations met with researchers, practitioners and representatives from peer-support programs in departments like Chicago, FDNY and Charleston, S.C., where their various experiences have provided an encyclopedia of “street smarts” regarding how to help firefighters help each other. The objective: Find workable ways to support firefighters playing active roles in keeping each other safe, healthy and productive.

Much evidence and experience demonstrate that peer participation can be critical in building success for occupational health programming. But there’s also a substantial body of research and experience that demonstrates risks associated with peer participation if the programs are not properly designed, carefully structured, well supervised and supported, continuously evaluated, and strongly integrated with effective professional services. Plus, the diversity of our nation’s fire service and the people who elect to serve means that effective approaches must be closely attuned to the climate and culture of the individual department and that no single approach will work for everyone.

With this in mind, the working group set its focus on developing easily accessible and inexpensive ways to identify best practices for peer participation, making them available to the diverse range of departments that comprise the American fire service, and supporting their development and functioning in ways that enhance firefighters’ ability to safely and effectively contribute to the health and safety of their coworkers and their organizations.

As complex as the issues may have appeared at the outset, the working group quickly found agreement on certain key goals and objectives for peer programs:
1. Peer support programs must work to keep firefighters safe and well. This approach is better than creating support programs so that their design and impact are based on responding to illness and injury. Those aspects are indeed very critical, but their effectiveness is greatly enhanced when the program and the providers are well established before a drastic need emerges. Relevance is built by identifying issues that matter on a daily basis and working as a part of the overall health and safety program to impact those issues.

2. Behavioral health reaches well beyond personal problems and occupational stress. Behavior and lifestyle choices are the major controllable factors in virtually all leading causes of firefighter mortality and morbidity. Issues like cardiovascular health, driving and situational awareness hinge on behavioral factors and improving outcomes demands behavioral change. Classes and programming can teach firefighters what they ought to do, but only active peer involvement can change what is actually done.

3. Recognition and referral are hallmarks of any effective behavioral health assistance program. The nature of the fire service can make this a complicated matter. Firefighters pride themselves on their problem-solving ability, which can sometimes make them reluctant to seek help. Even when help is wanted, it can be difficult for many to reach out. Even the best behavioral health assistance program can seem too great a leap to take unless there’s someone to help ease that transition. A trusted peer can help by recognizing the need, offering an approachable and confidential ear, and serving as an informed bridge to the necessary care.

4. When drastic circumstances happen, established peers are a critical resource. Many programs have focused on preparing peer personnel for dramatic roles in events that, for most departments, are fortunately somewhat rare. But perhaps more focus should be placed on preparing peers to address everyday issues. Those peers who do work effectively in this area are well positioned and well prepared to extend their roles when situations demand.

5. Peer programs need a vehicle for interaction and exchange. Whether in exchanging best practices and program ideas for ongoing issues or seeking expertise for a matter of crisis, peer support personnel need a way to talk to professional experts and experienced peer support providers so that solid, evidence-supported information can be available, ideas can be swapped, and new ideas disseminated.

The working group proposed a Web-based system to address these objectives, integrated with National Fallen Firefighters Foundation’s Everyone Goes Home website. You can learn more about the progress of this effort at www.everyonegoeshome.com.

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

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