Residential Wellbeing Program Pilot
ESF will begin to pilot a Residential Wellbeing Program in 2024 after the summer fire season.
This will involve six groups of ten people in residence for four days on the Mornington Peninsula to work with mental health counselors familiar with the emergency services environment.
The Residential Wellbeing Program has been informed by the British Columbia Firefighter Resiliency Program which was developed in response to a spate of suicides across the service. It was based on a program for military veterans developed by Dr Duncan Shields. Dr Shields and his colleagues facilitate the Canadian program which now extends to police officers.
The six ESF led pilot programs will take place between April and October 2024 and be open to participants from ESF member agencies who are assessed as sub-clinical or in the orange zone on the mental health continuum.
As a pilot program participants will be involved in a comprehensive evaluation program that replicates what has been undertaken for the Canadian program through Movember funding.
Rationale for the program
A gap has been identified in terms of early intervention initiatives for Victorian emergency service workers.
A Residential Wellbeing Program is being developed to fill that gap. There are no similar existing programs in Victoria that can provide the intensive early intervention to help avoid the risk of more serious mental injury and a collaborative sector wide approach to this initiative would provide efficiencies in a range of areas.
National and international research has established the critical importance of early intervention “to reduce the impact of developing mental health issues, and to minimise the impact that they have on people’s lives” (Lawrence et al. 2018, p. 113; see also Ortner 2003; Arango et. al 2018). Building on best practice learnings in public health, responding early and even prior to the presentation of symptoms is associated with improved health outcomes (McGorry 2008; Kupfer, Frank & Perel 1989). Early intervention encompasses a range of activities from promoting existing wellbeing to offering resources to support people with psychological distress and other early warning signs. It is linked to improved mental and physical health, better work productivity and community participation outcomes over time, and far into the future (Victorian Department of Health 2020).
Mental health conditions tend to develop slowly and increase in severity over time. Enabling personnel to have access to appropriate and early support mechanisms is critical for maintaining mental health, building resilience, and assisting people in times of struggle and crisis. In addition, early treatment and support can prevent the accumulation of stress build up and in doing so, reducing the chances of people becoming ill in the first place (Hodgson, Abbasi & Clarkson 1996; Muñoz et. al 2010). Targeting risk and promoting protective factors to prevent, halt and interrupt the onset and progression of mental injury has clear benefits in terms of reducing disease burden and compensation claims. The business case for this contemporary best practice is no better summed up than in the age-old expression “an ounce of prevention is worth a pound of cure”.
Early intervention features in the models and recommendations of experts and agencies working to improve mental health and wellbeing of Australian and International police and emergency service workers and volunteers. Based on their extensive study on this topic, Beyond Blue (2018) recommends emergency service workers “experiencing mental health symptoms or conditions, regardless of cause, having access to suitable early intervention services and supports”. The report continues, “such an approach would ensure that workers’ conditions are treated early – ensuring better outcomes and recovery, reduced time out of the workforce and a reduction in the number and complexity of claims arising” (Beyond Blue, 2018, p. 24).
Purpose and proposed pilot program scope
The purpose of establishing a Residential Wellbeing Program for Victorian emergency service workers is to:
· Assist serving (and potentially in future, retired) emergency workers to understand the mechanisms and effects of operational stress on the body, the brain, on behaviour and on relationships.
· Provide opportunity to discuss the impact of personal emergency response experiences with peers in a systemic and professionally facilitated environment.
· To equip participants with skills for self-regulation, effective communication, and planning strategies to maintain their resilience while facing ongoing operational challenges.
· To help minimise progression to serious mental injury and WorkCover claims.
ESFs approach to developing a Residential Wellbeing Program Pilot thus far is informed by the following:
· A Churchill Scholarship report which considers international wellbeing retreats for emergency responders
· Sponsoring the CEO at the UK Police Treatment Centre to visit Victoria in 2019 to meet agency heads and speak at the Emergency Management Conference
· An ESF Scholarship report which considers Australian public wellbeing retreats and what they could offer emergency workers.
· Discussions with founders of the British Columbia First Responder Resilience Program
· An ESF Learning Network working group which undertook preliminary consideration of program risks and implementation.
· Presentation by Canadian and NZ program leads to sector stakeholders.
· A comprehensive literature reviews.
· A qualitative study to understand the needs and expectations of such a program from emergency service workers.
· A preliminary business case
· Visit to Canada to participate in a program and speak with participants and partners
British Columbia First Responder Resilience Program
ESF considered various program approaches and options internationally. From this work it was determined that the British Columbia First Responder Resilience Program (BCFRRP) provides a model which best aligns with ESFs goals and which ESF could effectively emulate and tailor to local needs.
BCFRRP is a program built from an evidence-based model that was developed over 15 years for military veterans. It is delivered as a partnership between the University of British Columbia’s Men’s initiative and the BC Professional Firefighters’ Association. It is now also delivered to police and paramedics in Canada. Evidence of success comes from data collection and testimonials, and this is being comprehensively expanded with assistance from a Movember Grant.
ESF has established a working relationship with Prof Duncan Shields from the University of British Columbia and Steve Farina from the BC Professional Firefighters Association’ who have agreed to be strategic advisors/mentors for ESF as it develops its Residential Wellbeing Program (RWP). This is with a view to future collaboration in terms of data collection and sharing of experience.
The program’s design is influenced by the theories of Cognitive Behavioural Therapy, Exposure Therapy, Written Exposure Therapy, Life Review, Conflict Resolution and Communication Skills, Motivational Interviewing, Relaxation and Self-Regulation Training, and Mindfulness. The concept of change is shaped by Cognitive Processing Theory, Clinical Neuroscience, Group Theory, Gender Studies, and Seligman’s Positive Psychology Model.
Utilising principles of positive psychology and cognitive behaviour therapy, the program is designed to empower participants to manage their own mental health, reducing the risk of developing serious conditions and making a mental injury claim. To the best of our knowledge, there is no residential early intervention program specifically designed for emergency services in Australia, although it has been widely recognised as a need.
The Residential Wellbeing Program is small group-based intervention developed from the BCFRRP program but tailored to local needs. It will offer an intensive four days of skill development for those looking to strengthen their capacity to manage stress borne from organisational, operational, and familial situations.
It is an early intervention for people who are not clinically diagnosed with a serious mental health condition. They would sit in the orange zone of the mental health continuum.
It will be a professionally facilitated by two local mental health professionals familiar with the unique emergency services working environment and trained in program delivery by Prof Duncan Shields. The ESF Mental Health Advisory Group will assist to suitable facilitators.
A commercially operated facility situated in a natural environment on the Mornington Peninsula will be used for the Pilot programs.
The Pilot will involve the delivery of six intensive four-day residential programs over a 6-month period starting in April 2024 post the fire season. Each program will involve 10 participants. Participants will self-nominate for pre-program assessment though agencies may identify particular target groups for example drawing from a particular area of the State. For employees, a process of securing agency support for paid leave to attend the program will be negotiated.
The six cohort groups are yet to be finalised but would ideally be drawn from across the sector.
The program will target people at any stage of their career who are assessed (using standard psychometric tools and an interview undertaken by the facilitators) as sub-clinical or in the orange zone on the mental health continuum.
It is possible this assessment process will identify people whose risk is more advanced and therefore unsuitable for this program These people will be directed to appropriate services.
Programming will focus on education regarding the effects of operational stress and psychological trauma, building skills for self-regulation, communication skills and strategic planning for maintaining resiliency under ongoing operational load. The program is informed by principles from Cognitive Behavioural Therapy, Exposure Therapy and Written Exposure Therapy, Life Review, Conflict Resolution and Communication Skills, Motivational Interviewing, Relaxation and Self-Regulation Training and Mindfulness. The theory of change is informed by Cognitive Processing Theory, Clinical Neuroscience, Group Therapy, Gender Studies, and Seligman’s Positive Psychology Model.
Over four days participants are led through the program starting with the formation of a cohesive group to support a safe environment for later phases of the program. The psychoeducational components of day one provides them with the evidence-based rationale underpinning the program so that they understand the rationale for all activities.
The desired learning outcomes of the contact time are to provide the participants with:
a. A better understanding of the mechanisms and effects of single incident or cumulative operational stress on the body, on the brain, on behaviour and on relationships.
b. An improved capacity to support their peers and strengthened knowledge and skills to maintain personal resilience and wellbeing.
c. Increased awareness of the impact of personal emergency response experiences on self and others the impact of gender on the experience of stress and how it is interpreted and communicated with others.
d. A personal psychological wellbeing tool kit and strategic plan to maintain resiliency and wellbeing under operational load, and to identify and mitigate potentially overwhelming experiences in their roles through appropriate skills and resources.
e. Skills to improve relationships with peers, partners, and family members.
f. Connection to services, supports and resources to better maintain their own resiliency and support their peers.
As a point of difference to the BCFRRP each participant will be encouraged to nominate a significant other who is considered their main ‘support crew’. These people will separately come together with the facilitators to understand what the program has provided to the participants, how the role of support crew is vital to ongoing success post program, and what that will require.
Two, two-hour virtual refresher courses will be offered to participants at six weeks and 12 weeks post program completion to help consolidate learning.
Data will be collected on entry to the program, at four weeks and six months post the program. It will be independently analysed and reported on.