IAFF Peer Support Training Overview TALKING POINTS IAFF is intensifying its focus on behavioral health and has rolled out: Reveal 1: The 3rd Edition of the Wellness-Fitness Initiative includes behavioral health and how to develop a comprehensive program. Reveal 2: An online behavioral health awareness course, two-hour self-paced course that covers PTSD, suicide prevention and resiliency. Reveal 3:The two-day Peer Support Training. Reveal 4:The Center of Excellence for Behavioral Health Treatment and Recovery, which will be covered on the last slide. International Association of Fire Fighters

IAFF and Behavioral Health TALKING POINTS In response to these trends and concerns expressed by members, IAFF is intensifying its focus on behavioral health Reveal 1: The 3rd Edition of the Wellness-Fitness Initiative includes behavioral health and how to develop a comprehensive program. Reveal 2: Over the last year, IAFF has developed the online behavioral health awareness, which is a pre-requisite for being a Trained Peer Supporter.. Reveal 3: The IAFF has developed this two-day Peer Support Training. Reveal 4: The IAFF Center of Excellence for Behavioral Health and Treatment, residential treatment center opened in March 2017 in Maryland. We’ll talk more about this resource on Day 2. International Association of Fire Fighters

Peer Support from a Fire Fighter Perspective Support from someone who has “been there” to help with recovery Shared experience provides a safe environment for processing reactions, thoughts, etc. International Association of Fire Fighters

Where Does Peer Support Fit? CISM Peer Support Chaplain EAP Clinicians Community programs = Bridge to Other Resources TALKING POINTS Peer support does not replace other behavioral health models (like CISM). It is another tool in the toolbox Note peer support can help with other life (non-PTE) issues like divorce, etc. For final reveal: Peer support does not replace behavioral health professionals or other supports like chaplains; peers can serve as a bridge to these resources. International Association of Fire Fighters

IAFF Trained Peer Supporters IAFF Trained Peer Supporters are trained members of the fire service who seek out and talk with other peers about behavioral health concerns and connect members with helpful services. TALKING POINTS Through this training, members will obtain the knowledge and skills to support your peers. Once they complete the two-day course and the online course, they are certified as IAFF Trained Peer Supporters.   Some departments already have established peer support programs and their expertise has guided the development of this training. We’re helping you learn the necessary skills to be effective Trained Peer Supporters. We’ll also train you to go back to your communities and lead the development of an effective peer program for your own department, including recruiting more peers. International Association of Fire Fighters

Peer Support Training Agenda Day One Active Listening Skills Confidentiality Assessment Skills General Assessment Suicide Risk Assessment Good Self-Care Day Two Crisis Intervention Skills Action Planning Engagement Skill Building Program Development TALKING POINTS The training covers the essential skills, including suicide risk assessment. This is a skill-based training; it’s very interactive and a safe place to practice and make mistakes. International Association of Fire Fighters

It’s the cornerstone of peer support. Active Listening Active listening is defined as the process of truly hearing a member’s state of mind and encouraging them to open up and trust. It’s the cornerstone of peer support. TALKING POINTS Provide a brief intro to types of slides/discussions from the training. DISCUSSION Ask: “What do you see in this photo that “looks” like active listening?” Good eye contact, happy facial expressions, comfortable stance. International Association of Fire Fighters

International Association of Fire Fighters Active Listening Active listening focuses on two levels of communication: Verbal communication (actual words, tone, volume and pace of speaking) Non-verbal communication (e.g., eye contact, head nodding, posture etc.) Pay attention to what the member is communicating: 55% = body language 38% = tone of voice 7% = actual words spoken! TALKING POINTS Active listening involves looking for both non-verbal and verbal communications. Active listening means staying present as person is talking; not anticipating what they may say or rehearsing what you want to say next. If asked, percentage breakdown for verbal/non-verbal communication is widely-cited and from a 1967 study by researcher Albert Mehrabian. DISCUSSION Ask: “What are examples of verbal communication that you should pay attention to? Elicit responses and reveal/discuss bullets. Ask: “What are examples of non-verbal's?” Elicit responses and reveal/link bullets. Ask: “What percentage of communication occurs non-verbally?” Ask: “Who is nervous about being a Trained Peer Supporter and not knowing what to say?” What do these percentages tell you? It’s called Active Listening and not Active Talking. International Association of Fire Fighters

International Association of Fire Fighters Establishing Trust Trained Peer Supporters use both verbal and non-verbal communication to establish trust. Make eye contact Calm presence Listen with your heart Show interest, understanding and general concern Convey respect and objectiveness Establish your own style Remember the percentages! How you say it is more important than what you say. TALKING POINTS Active listening is needed to establish trust. Demonstrate your interest in the member as an individual, getting across that you respect their view. It’s more important to communicate by listening with your heart vs. finding the exact right words to say. Should be a relief for Trained Peer Supporters worried about, “What am I going to say?” This will take time, and you need to use your own authentic style. International Association of Fire Fighters

International Association of Fire Fighters Confidentiality Trust and confidence in the peer program depends on confidentiality. How do you respect this trust? Don’t talk about the member with others. Keep identity and information about the member private. Arrange for privacy when talking to a member. When is it appropriate to NOT keep things private? Person gives you consent to communicate with others You are a mandated reporter There is an immediate threat to self or others DISCUSSION Ask: “What are ways to ensure privacy and maintain trust?” Elicit responses and reveal/discuss bullets. Need to protect privacy even when responding to genuine questions/concerns about the member Ask: “If you’re the Trained Peer Supporter, how do you handle it if you see someone out in public? You can tell the member: “If you see me around, you decide whether we acknowledge each other. I will follow your lead.”      Ask: “When is it OK to break confidentiality?” Elicit responses and elaborate on each bullet Consent given: Ask permission before talking to community resource/spouse/etc. Mandated reporter: Many helping professionals are required by law to report incidents of elder or child abuse. Threat to self or others: Suicidal, homicidal. Includes on-duty safety risks. International Association of Fire Fighters

International Association of Fire Fighters General Assessment Have there been any changes in: Mood Behavior Thinking Life Events You are looking for changes in how a person typically acts and are concerned when those changes begin causing problems in his or her life. TALKING POINTS Emphasize looking for changes. Need to use Active Listening skills to determine these changes. Signs of behavioral health difficulties do not mean absolutely that there is a problem, but they can serve as an early warning system for difficulties. The more signs you see over time, the more likely it is that there may be trouble for the member. Trained Peer Supporters are not expected to be clinicians and do in-depth clinical assessments. Avoid the use of mental health labels; Never diagnose. DISCUSSION Ask: “What would you be on the lookout for if you’re concerned someone might be experiencing a behavioral health issue?” Elicit responses and reveal/discuss bullets.    International Association of Fire Fighters

International Association of Fire Fighters Suicide Canada Nearly 4,000 Canadians die by suicide each year – an average of almost 11 suicides a day. U.S. 42,773 people completed suicide in 2014. Fire Fighters Suicide ideation = 47% Suicide plans = 19% Suicide attempts = 15.5%. TALKING POINTS Recall from the online training, the statistics on suicide are alarming. Fire fighter stats from 2015 study of 1,000+ current and retired fire fighters over course of their careers. 2015 study also found that key factors associated with increased risk for reporting suicidal thoughts and behaviors included lower firefighter rank, fewer years of firefighter service, membership in an all-volunteer department, a history of professionally responding to a suicide attempt or death, and active duty military status. References (if asked) U.S.: 2014 stat is from CDC’s Web-based Injury Statistics Query and Reporting System(WISQARS™) More than auto accidents is from federal Substance Abuse and Mental Health Services Administration (http://www.samhsa.gov/suicide-prevention) Canada: Centre for Addiction and Mental Health http://www.camh.ca/en/hospital/about_camh/newsroom/for_reporters/Pages/addictionmentalhealthstatistics.aspx Fire Fighters: “Career prevalence and correlates of suicidal thoughts and behaviors among firefighters” in Journal of Affective Disorders by Stanley, Horn, Hagan and Joiner (November 15, 2015). International Association of Fire Fighters

International Association of Fire Fighters Suicide Risk There are an estimated 25 suicide attempts for each suicide death, about one attempt every minute. 80% of those who complete suicide have told someone about their intentions. Suicide is preventable! The IAFF Peer Support Training course will prepare you to recognize and assist suicidal firefighters. Statistics: American Association of Suicidology, Suicide in the USA, Fact Sheet. Based on 2012 data (2014). International Association of Fire Fighters

Suicide Risk Assessment Generally speaking, suicidal ideation doesn’t exist on its own. In fact, a large percentage of those who commit suicide were also suffering from major depression. And we know that people with behavioral problems are at higher risk for suicide than those who do not. There’s concern when those changes begin causing problems in his or her life. International Association of Fire Fighters

International Association of Fire Fighters Secondary Trauma Compassion fatigue is a consequence of care-giving characterized by a decreased ability to feel empathy and understanding of another. You’ve “run out of juice” for your leadership role. TALKING POINTS Compassion fatigue = stress that results from care giving Initial thoughts are usually: “I’m feeling stressed.” Left unaddressed, compassion fatigue ends up as burnout. Bottom line: You need to look out for yourself, just like you do for brothers and sisters. Highlight Compassion Fatigue Self-Test in manual’s appendix and review a few questions. Higher score, higher potential for vicarious trauma or burnout. Remind group this is a good tool for checking-in down the road. International Association of Fire Fighters

International Association of Fire Fighters Secondary Trauma Vicarious trauma is what happens when someone else’s trauma is experienced as if it happened to you. Vicarious trauma effects can occur at anytime and anywhere and may be cumulative. TALKING POINTS Trained Peer Supporters risk vicarious trauma occurs when the stories of survivors become traumatizing to the listener An example to clarify: “If ______ (refer to other trainer) pulls 5 kids out of a fire, s/he may experience trauma and develop PTSD from that direct experience.” “If I have never been in that situation (pulling 5 kids out of a fire), hear about it as a Trained Peer Supporter and feel traumatized by it, THAT’s vicarious trauma. DISCUSSION Ask: “What’s the difference between compassion fatigue and vicarious trauma? Vicarious trauma is akin to secondary PTSD. Without proper support and assistance, symptoms can worsen and quickly lead to burnout. Ask: “How many people share stories about the job with spouses or other family members?” Be aware that vicarious trauma can also affect family members. International Association of Fire Fighters

Signs of Burnout Exhausted emotionally and physically Negative attitudes – toward the job or home Loss of satisfaction from job Again, prevention is key!! Be committed to self-care!. TALKING POINTS Burnout can occur when you haven’t noticed/addressed compassion fatigue or vicarious trauma. Neuroimaging studies of people who report burnout reveal similar brain images as those who experienced early-life trauma. It’s hard to walk-back from burnout, so prevention is key. International Association of Fire Fighters

International Association of Fire Fighters Self-Care 101 Prevention is key! Use these self-care tools: Enjoyable Activities Awareness of Personal Triggers Boundaries. TALKING POINTS Trained Peer Supporters need to be proactive to prevent or address compassion fatigue or vicarious trauma. DISCUSSION Ask: “ How do you recharge and engage in self-care?” You also need to be self-aware enough to notice when you neglect these self-care activities; setting yourself up for negative things to happen. Ask: “What are examples of personal triggers that could trigger you? And possibly lead to compassion fatigue or vicarious trauma?” Personal history, current personal status, preconceived notions or stereotypes. International Association of Fire Fighters

International Association of Fire Fighters Resiliency Tools Connections Action Flexibility Humor Imagination Strengths TALKING POINT Building resilience helps to PREVENT compassion fatigue. DISCUSSION Ask: “What is resilience?” Being able to bounce back/does NOT mean you don’t experience distress. Resilience is not a trait. It’s a pattern of thoughts, behaviors and actions. It can be learned! Ask: “What are ways to build resilience?” Unplug/de-stress Spend time and have fun with family, friends and kids Read Go to movies Hang out with colleagues away from the station. Ask: “Here are the tools for building resilience. What do we mean by Connections?” Go through bullets and ask participants for more details about each ‘tool’?” Maintain connections to fire family and family at home. Take concrete action. Do something vs. detaching/wishing issue goes away. Be flexible. Sometimes need to experience strong emotions, sometimes need to limit them. Good to do both. Humor helps keep perspective. Imagination. Imagine how you would LIKE to see things. Or, use imagination to take temporary mental break. Strengths. Know yourself. Capitalize on and build your go-to strength International Association of Fire Fighters

“ABC” Model of Crisis Intervention A: Approach B: Basics C: Coping TALKING POINTS The ABC Model is based on skills you’ve learned during the training. Now you’re applying the skills to a crisis or urgent situation. International Association of Fire Fighters

“ABC” Model of Crisis Intervention The end goal is to help the member stabilize emotions and regain sense of control. TALKING POINTS All the problems will not be solved after the crisis intervention; but the member will feel more in control. Once emotions have stabilized, member can tackle remaining concerns. Sometimes the member can address remaining concerns with their natural support system and sometimes will need support of Trained Peer Supporter. International Association of Fire Fighters

International Association of Fire Fighters Action Planning Long-Term Plan Assist firefighters with developing their own plans They must do the work Follow-Up Wrap-Up TALKING POINTS All the problems will not be solved after the crisis intervention; but the member will feel more in control. Once emotions have stabilized, member can tackle remaining concerns. Sometimes the member can address remaining concerns with their natural support system and sometimes will need support of Trained Peer Supporter. International Association of Fire Fighters

International Association of Fire Fighters Types of Engagement Outreach visit/call Requested visit/call Deployment following traumatic event Education TALKING POINTS Peer support teams are intended to be proactive and not simply reactive. By engaging members at non-crisis times, peers are able to intervene before problems escalate, educate and reduce stigma. DISCUSSION Ask: “You’re trained up as a Trained Peer Supporter. What are some ways to connect with members?” Elicit responses and reveal/discuss bullets. International Association of Fire Fighters

Skill Building Practice Additional opportunities to practice skills using new scenarios. Practice essential skills of: Active Listening Assessment Action Planning TALKING POINTS This module allows participants to integrate and practice their skill sets. Everyone participates, so everyone gets a chance to practice their skills. International Association of Fire Fighters

International Association of Fire Fighters Program Development Administration Buy-in Peer Program Models Recruitment of Peers EAP’s Behavioral Health Consultant Referral Network Outreach Relevant SOP’s Outcome/Impact TALKING POINTS The two-day training finishes with time spent on developing or advancing a peer program. These are the topics of most interest to developing Peer Programs. International Association of Fire Fighters

International Association of Fire Fighters Recruitment Recruit new peers Selective recruitment (e.g., invite-only) Open recruitment (e.g., broad invite) Retirees Screening Training TALKING POINTS Recruiting Good way to selectively recruit: Ask others: “If you had a personal problem, name the top three people in your department that you would talk to.” Open recruiting can help you build an informal peer resource network: Ask members to serve as a resource for individuals with similar concerns. Screening The goal is to expand the team with the right people; a screening process will help regardless of the type of recruitment. Talk with your clinician to determine how to screen potential members (e.g., how long they need to be in recovery to be considered.) Plan your response for people who want to serve as a peer but don’t have the necessary characteristics. Training New members should be mentored/supervised by Trained Peer Supporters who’ve gone through the training. Create an expectation that all Trained Peer Supporters – new and old – will carry themselves appropriately, including use of social media. Otherwise, it may be difficulty for members to open up and trust them. DISCUSSION Ask: “What are some good characteristics for a Trained Peer Supporter?” Varied responses. Ask: “What are the advantages of selective recruitment? What are the challenges?” Plus: Obtain trusted members; speedy recruitment Challenges: Miss out on potentially good peers; disgruntled feelings of those not asked. Ask: “What are the advantages of open recruitment? What are the challenges?” Plus: Transparent process; increased awareness of peer program; better chance of diversity/variety in peers. Challenges: Time-consuming application and screening process; disgruntled feelings of those turned-away. Ask: “What are the advantages of recruiting retirees? What are the challenges?” Plus: Knowledgeable. Experienced. Available time. Challenges: ?? Ask: “What are some criteria for screening potential Trained Peer Supporters?” Demonstrated ability to listen/be trustworthy Some length of time since dealt with own behavioral health/substance issue Models healthy behaviors (or, at least, doesn’t model unhealthy behaviors) Ask: “How can you train new recruits?” IAFF resources: online class, future two-day training Mentorship by experienced IAFF Trained Peer Supporter International Association of Fire Fighters

International Association of Fire Fighters Hosting a Training Must be requested by Local President via 13th District Vice President Fred Leblanc Class maximum is 30 participants. Cost is $7,500. Some Hosts open up training to nearby affiliates and collect $250 per participant to share the cost. Detailed information on the “Peer Support Training Information Guide” on www.iaff.org/behavioralhealth. TALKING POINT Currently scheduling in spring 2017. International Association of Fire Fighters

International Association of Fire Fighters Training Schedule August – December 2016: 11 trainings completed February – June 2017: 20 trainings scheduled There is a waiting list for individual members who want to attend another Local’s training when/if space is available (which doesn’t happen often). International Association of Fire Fighters

IAFF Center of Excellence 855-900-8437 IAFFRecoveryCenter.com TALKING POINTS Residential treatment center for IAFF members with substance abuse and co-occurring PTSD, depression and anxiety. Located in Upper Marlboro, Maryland outside of Washington, DC. IAFF Advisory Committee involved with designing facility and treatment protocol. Paid for through member’s health insurance. It will open in March 2017. International Association of Fire Fighters

IAFF Behavioral Health Program Patrick Morrison, Assistant to the General President Jim Brinkley, Director, Occupational Health and Safety Elaine Viccora, Behavioral Health Specialist behavioralhealth@iaff.org International Association of Fire Fighters

No Firefighter Stands Alone International Association of Fire Fighters

International Association of Fire Fighters