By Paul Luizzi
Photo above by Chris Radoian (njtoaz.smugmug.com)
The behavioral health needs of the communities that we all serve is an ever-growing issue and represents one of the many challenges to a fire department’s response capability. The Goodyear (AZ) Fire Department over the last few years has noticed an increase in behavioral health needs by our firefighters. This case study will examine how we approached the behavioral health and wellness program for all our employees. To maintain a high level of job performance, uniformed personnel must be able to cope effectively and balance the emotional, physical, and mental stresses of work and personal life. If the ability to cope becomes compromised, these stresses may act to unbalance his or her mental and emotional health.
The city of Goodyear is one of the fastest growing cities in the United States with a population of more than 80,000 citizens. The city of Goodyear Fire Department employs over 100 employees, 93 of which are sworn. The Goodyear Fire Department is an “all-hazard” emergency response agency. Our members are trained and equipped to provide medical services, fire, hazardous materials mitigation, community education, and emergency management. The department participates in the Metro Phoenix Automatic Aid Regional Response System and deploys two paramedics assigned to each fire crew per shift. Clinical oversight is provided through the department along with a base hospital and an administrative medical director.
Framing the Issue
The correlation between an increased number of behavioral crisis calls in the community and the increased number of Goodyear Firefighters exhibiting behavioral health problems cannot be ignored. During a three year analysis period, more than 10 percent of the department had been impacted by behavioral health issues: post-traumatic stress disorder, anxiety, and sleep disorders, which do not appear to trend in a specific causal category. We know that a truly comprehensive wellness program must provide continual information, education, support, access to resources, and a support network. One of the department’s labor management goal was to provide total wellness for our employees. The International Association of Fire Fighters (IAFF) Wellness Fitness Initiative defines wellness as a balance between medical, physical, emotional, and behavioral aspects. The city and department invest annually in the employees to ensure that the have the capability to provide high-quality service to our citizens. We invest by providing annual comprehensive medical physicals which include, but are not limited to, medical screening, VO2 Max testing, calcium scoring, and functional movement screening. Behavioral health augmentation, like the other components of the program, can only be effective if it is used by both the department and the individual. A truly comprehensive wellness program must provide continual information, education, support, access to resources and a support network.
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Initial strategies to address these issues, including the implementation of a Web-based behavioral health program called Firestrong and the Employee Assistance Program (EAP). Overall feedback from the employees was that the programs provided some assistance, however they did not have the desired results of full recovery from their symptoms.
Command staff realizes that this is a silent crisis. In addition to Firestrong and EAP, Goodyear Fire has a volunteer chaplain who has been involved with command staff to address some of the behaviors observed by crews that appear to be unusual, including isolation, mood shifts, and poor eating/sleeping habits. The command staff recently concluded that some of these individuals do not want to seek out the chaplain because they think that the assistance offered will be religious in nature. Whereas Firestrong has beneficial resources, we recognized that it is a stop-gap solution, not a comprehensive solution. We also looked at the number of sick days used and increased number of firefighters requesting leave due to stressful calls. If anything, the number of requests for information from firefighters to the Firestrong Web site was a clear illustration of the need for a behavioral assessment of the entire fire department.
On the opposite side of the spectrum, the city of Phoenix, which far surpasses the city of Goodyear in size and population, experienced four firefighter suicides within a seven-month span in 2010. Phoenix created a crisis services unit with programs to assist firefighters with the issues Goodyear is facing. Without the financial resources Phoenix has, Goodyear is unable to follow such a model. After consulting with the head of crisis services in Phoenix, it is clear that the fire department needs a better understanding of where to start in order to address these new issues. The long-term solution would be to identify the magnitude of the city’s needs and then provide sufficient resources.
Operational Impacts
For firefighters that require weeks or months to deal with their total wellness, the department must result to using overtime to ensure full staffing. Every year when the budget is developed, the overtime budget estimate is based on infrequent absences and known events. However, behavioral illnesses often result in long-term absenteeism. The first type of overtime is Fair Labor Standards Act (FLSA) or scheduled OT, in which firefighters assigned to shift receive overtime pay (1.5/hour) for any hours worked over 106 hours in a pay period. The second type of overtime is Constant Staffing (CS), which is used to cover vacancies in a shift due to illness, injury, special event, or vacation. The Goodyear Fire Department’s budget for FY2015-16 was $1.8M. Overtime accounts for 15 percent of the personnel budget excluding FLSA or 18 percent including FLSA. For the current fiscal year, the fire department has spent more than half of their overtime in the first quarter of the fiscal year. The overtime spent to date accounts for both constant staffing and FLSA. In terms of constant staffing costs alone, not associated with FLSA, they have expended $1,200,000 or 64 percent of their budget to date.
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Program Launch
In 2016, the fire department executive staff put forward a plan to pilot an on-site behavioral health program that would provide training and site visits by a licensed mental health professional. We submitted a 2016 Assistance to Firefighters Grant application and were awarded $36,000 to trial the program. We posted a solicitation for qualifications to meet the needs of the department and eventually the pilot program was awarded to Dr. Tania Glenn and Associates. During the pilot program, Dr. Glenn agreed to be “on-site” with the department for a minimum of five weeks during the performance period of the project. Dr. Glenn agreed to provide stress resiliency training to all personnel in large group settings, train a peer support team, and offer one-on-one clinical visits for those who voluntarily agreed to sign up for her services. The program had very positive feedback after the first week and continued to have positive feedback for the entire performance period. We had close to 40 percent of the department visit Dr. Glenn during the performance period and many reported that they felt much better than with other services that we previously provided after meeting with her. We had no negative feedback about the program and did not experience any other hurdles. In fact, we had an interesting attitude change in firefighters: members began holding each other accountable for their own behavioral health and openly telling their peers how strongly they believe in the program. At the end of the performance period, the department felt so strongly about the program that we sought permission from the city council to make this an ongoing budget supported program. In 2017, the program was approved and supported by city council and is now part of the fire department budget.
Program Sustainability
Since July 2017, Dr. Glenn has been visiting the fire department four to five weeks per fiscal year. Dr. Glenn is also available by phone 24/7 so that crews can have the necessary support after high-stress incidents (drownings, hangings, sudden violent deaths) and she will also triage the calls from the peer support team or me to better understand if she needs to be on-site for the employee. This played out during the December holidays when the crews went to a particularly disturbing call involving an infant. We quickly deployed the peer support team, however it was a couple weeks later when the peer support team realized that two crew members were displaying behaviors consistent with delayed stress response and post-traumatic stress disorder (PTSD). Dr. Glenn and I spoke on the phone and we made the decision to bring her on-site to deal with two crew members who were struggling. After her visit, both crew members reported feeling much better and are not having any further symptoms after visiting with Dr. Glenn. We continue to build our stress resiliency through training and one-on-one clinical visits. Dr. Glenn is also working to continue to develop our peer support team, which has been deployed multiple times for high-stress incidents. The department is also working on developing a family support program, which could be voluntarily activated after high-stress incidents to ensure that the employee and their family have the mental health support that they need.
The Goodyear Fire Department has an exceptional tradition of delivering outstanding customer service. Some of the most talented individuals in the fire service work here. Members of the department spend hundreds of hours every year learning the latest response technology and honing their technical skills in training sessions. Dr. Glenn and I meet every week that she is in town. As we reflect back on how far we have come, we realized the great strides we have made with very little pushback from the employees. As I stated previously, 40 percent of the organization’s members have seen Dr. Glenn at least once and quite a few see her on a continuous basis, if nothing else to talk through issues that they are experiencing. The department has been blessed with an open-minded approach to the program and further blessed by a mental health professional who really gets what we do. As the fire chief, I feel it is our obligation to seek out the most appropriate resources to help our coworkers cope with the traumas and stressors that are part of the work we do every day to ensure our firefighters can respond to the needs of our citizens in a professional and expeditious manner. Every member of this department is dedicated to service. If they need additional support to continue their mission, the city is committed to getting it for them.
Paul Luizzi is the fire chief of the Goodyear (AZ) Fire Department.
