Assessment of psychological functioning in retired firefighters.

The past decade has witnessed increased clinical and investigative attention directed to the mental health of active-duty firefighters. Yet, to our knowledge, no investigations have focused on the well-being of retired firefighters, despite awareness of retirement posing significant challenges for many older adults in general, and, in particular, first responders. The purpose of this study was to (a) conduct an initial assessment of psychological functioning in 315 retired firefighters, (b) examine the relationship between overall psychological functioning and self-concept clarity (i.e., the extent to which an individual's self-concept is clearly defined, internally consistent, and temporally stable), and (c) determine whether self-concept clarity moderates and/or mediates relationships between psychological functioning and relevant demographic and personal variables. Results indicated firefighters suffer from mental health symptoms associated with psychological disorders, such as depression and posttraumatic stress disorder, at higher rates than their same-aged counterparts in the general population. Furthermore, results showed that factors like age, length of time on active duty, and length of time retired, each significantly correlated with overall psychological functioning. Finally, results suggested that self-concept clarity both mediates and moderates the association between overall psychological functioning and personal factors such as daily levels of pain, feelings of financial stability, and access to affordable health care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cultivating a Resiliency Model for Emergency Department and Intensive Care Unit Staff Through Peer Support: A Program Description.

Emergency department (ED) and intensive care unit (ICU) staff experience significant and ongoing exposure to mental health trauma due to the extremely high number of tragic cases consistently seen. Despite awareness of the magnitude of this problem, there is a scarcity of clinical efforts directed toward reducing and managing secondary traumatic stress and vicarious trauma. In an effort to promote resiliency in these frontline workers, we describe development and implementation of the Adapted Peer Support Resiliency Program (APSRP), a psychoeducational and cognitive reframing behavioral-based program equipped with peer support professionals who are trained in cognitive-behavioral strategies specifically tailored toward the needs of this population. The APSRP is an adaption of concepts and coping skills utilized by the Penn Resilience Program, which has previously demonstrated efficacy in combating a range of psychological problems (e.g., anxiety, depression, substance abuse, eating disorders, and severe mental illness). The APSRP incorporates a range of cognitive-behavioral strategies inclusive of cognitive reframing skills, role-playing, and behavior rehearsal. This proposed program was facilitated and supervised by a licensed mental health professional and implemented by fellow ED and ICU peer professionals. Components of the APSRP model are discussed. Suggestions for directing future efforts within this needed area are offered.

A Behavioral-Analytic Model for Assessing Stress in Firefighters.

Research has documented a number of acute and chronic stressors unique to the fire service. Due to the rise in mental health concerns in firefighters, there has been increased awareness of the negative effects of unmanaged stress. The present study employed a behavioral-analytic model to construct a brief screening measure of stress for this population: the Firefighter Assessment of Stress Test (FAST). Psychometric properties of the FAST were evaluated using data from active-duty firefighters throughout the United States. Results indicated the FAST has good internal reliability (α = 0.89), as well as good convergent and discriminant validity. Also, the factor structure of the FAST revealed three significant subscales reflective of stress associated with responding to calls, administrative difficulties, and being overworked. Scoring and interpretation guidelines were established to suggest when further assessment is warranted. The FAST offers a brief and valid method of self-assessment of current stress levels in firefighters. Information obtained from the FAST (i.e., overall stress level and domains) has the potential to facilitate more immediate identification and recognition of stress in firefighters than what has been possible to date. Moreover, heightened awareness of stress and its effects will hopefully culminate in expanded efforts directed toward stress reduction and intervention for firefighters and their families.

Relationship Between Posttraumatic Stress Symptoms and Cardiovascular Disease Risk in Firefighters.

The impact of occupational stress on first responders has received increased investigative attention in recent years. However, research specifically targeting firefighters and their unique responses to job related stress remains limited. Although cardiovascular disease (CVD) risk has been recognized in firefighters, behavioral and psychological contributions (e.g., posttraumatic stress) have not been adequately examined. The purpose of this study was to: (1) examine the relationship between posttraumatic stress symptoms and CVD risk in firefighters, (2) assess the effects of service time on the relationship, and (3) increase understanding of the manifestations of stress in this population. Participants were 87 firefighters from Special Operations teams. Self-report measures of posttraumatic stress symptoms, health, and length of service were administered. Data from annual physical examinations provided information regarding CVD risk (weight, height, blood pressure, cholesterol, smoking, physical exercise). Results indicated significant relationships between posttraumatic stress symptomatology and current smoking status, triglyceride levels, and the number of CVD risk factors. Findings suggest that the presence of posttraumatic stress symptoms may influence overall CVD risk and may not be moderated by years of fire service. Implications for behavioral interventions with firefighters are discussed. Suggestions for future research in this area are offered.

Firefighter Stress and Mental Health: Introduction to the Special Issue.

The past decade has witnessed burgeoning interest and concern regarding the mental health of firefighters. This increased attention is due, in part, to research documenting higher rates of psychiatric problems, including depression, substance abuse, sleep disturbances, posttraumatic stress disorder, and suicidality in fire rescue personnel compared to civilians. Similarly, the National Institute for Occupation Safety and Health (2014) has identified disturbingly elevated rates of physical health difficulties in firefighters, most notably high blood pressure, coronary heart disease, death due heart attacks, as well as different forms of cancer. Despite the heightened awareness of the mental and physical health challenges in this population, behavioral research specifically targeting firefighters is limited. With this is mind, we asked prominent researchers and clinicians working in this area to present results of their early investigative efforts in our Special Issue on "First Responder Stress and Mental Health". In this Introduction, we provide brief summaries of the studies comprising the Issue. Articles in this issue address topics of sleep, PTSD, substance use, physical health concerns, and provide assessment and treatment considerations. A primary goal of the Issue is to stimulate further behavioral research with this group of deserving yet underserved first responders. Moreover, the Issue serves as a tribute to the men and women of the fire service who dedicate and risk their lives to serve their community.

A controlled evaluation of family behavior therapy in concurrent child neglect and drug abuse.

OBJECTIVE: Approximately 50% of child protective service (CPS) referrals abuse drugs; yet, existing treatment studies in this population have been limited to case examinations. Therefore, a family-based behavioral therapy was evaluated in mothers referred from CPS for child neglect and drug abuse utilizing a controlled experimental design. METHOD: Seventy-two mothers evidencing drug abuse or dependence and child neglect were randomly assigned to family behavior therapy (FBT) or treatment as usual (TAU). Participants were assessed at baseline, 6 months, and 10 months postrandomization. RESULTS: As hypothesized, intent-to-treat repeated measures analyses revealed mothers referred for child neglect not due to their children being exposed to illicit drugs demonstrated better outcomes in child maltreatment potential from baseline to 6- and 10-month postrandomization assessments when assigned to FBT, as compared with TAU mothers and FBT mothers who were referred due to child drug exposure. Similar results occurred for hard drug use from baseline to 6 and 10 months postrandomization. However, TAU mothers referred due to child drug exposure were also found to decrease their hard drug use more than TAU mothers of non-drug-exposed children and FBT mothers of drug-exposed children at 6 and 10 months postrandomization. Although effect sizes for mothers assigned to FBT were slightly larger for marijuana use than TAU (medium vs. large), these differences were not statistically significant. Specific to secondary outcomes, mothers in FBT, relative to TAU, increased time employed from baseline to 6 and 10 months postrandomization. Mothers in FBT, compared to TAU, also decreased HIV risk from baseline to 6 months postrandomization. There were no differences in outcome between FBT and TAU for number of days children were in CPS custody and alcohol intoxication, although FBT mothers demonstrated marginal decreases (p = .058) in incarceration from baseline to 6 months postrandomization relative to TAU mothers. CONCLUSION: Family-based behavioral treatment programs offer promise in mothers who have been reported to CPS for concurrent substance abuse and child neglect of their children. However, continued intervention development in this population is very much needed.

A standardized method of preventing and managing emergencies within the context of evidence-based therapy implementation.

Families served within child welfare settings evidence a wide range of emergencies or unexpected crises or circumstances that may lead to danger and make it difficult for them to focus on treatment planning. Mental health treatment providers are often unprepared to effectively manage emergencies during implementation of evidence-based prescribed therapy sessions. In this study, the authors empirically developed a standardized intervention to assist mental health providers in emergency prevention and management (EPM) with their clients. EPM includes assessment of emergent conditions and a self-control procedure that may be utilized by consumers to prevent or resolve emergencies. EPM responses of 26 mothers referred by Child Protective Services for 6 months of evidence-supported treatment were examined. Relevant to clinical utility, the results indicated that providers implemented EPM in a little more than half (56.9%) of their treatment sessions, and all emergencies assessed in EPM were endorsed by at least 8% of the sample throughout their treatment. EPM was implemented with fidelity according to service providers, and corroborated by blind raters. Participants were found to be compliant and satisfied with EPM. The average number of emergencies endorsed over the course of EPM administrations was negatively correlated with the frequency of EPM administrations, suggesting that EPM may have helped reduce emergencies. Pretreatment factors (e.g., household income, child abuse potential, family functioning, parental stress, child behavior problems, number of days child removed from home) and hard drug use (but not marijuana or alcohol) during treatment were associated with the number of emergencies reported by participants.

Crisis intervention team (CIT) training in the jail/detention setting: a case illustration.

Research has documented the over-representation of persons with severe and persistent mental illness (SPMJ) in jails and prisons. Further increased attention has been directed to jail diversion programs and other attempts to prevent incarceration of adults with SPMI. Yet, regardless of available diversion programs, and recent trends in mental health within correctional settings, jails continue to see a disproportionate increase in inmates with SPMI. Thepurpose of this paper is to provide an overview of the research, public policy, and current best practices for the development and implementation of Crisis Intervention Team (CIT) Training as an in-house intervention in jail/detention-based settings. Our review provides support for deploying this specialized law enforcement response program to address the needs of mentally ill persons within jail settings. Strategies and issues in the utilization of the CIT model in detention contexts are discussed.

Family Behavior Therapy for Use in Child Welfare: Results of a Case Study Involving an Abused Woman Formally Diagnosed With Alcohol Dependence, Bipolar Disorder, and Several Anxiety Disorders.

The results of a multiple-baseline case study of family behavior therapy (FBT) is described in a woman formally diagnosed with alcohol dependence, bipolar disorder, generalized anxiety disorder, specific phobia, and panic disorder. She was referred to treatment from the local Department of Family Services for child neglect and domestic violence. After baseline measures were administered, the first phase of treatment involved home safety tours aimed at reducing home hazards and cleanliness. A second phase of treatment additionally targeted family relationships through communication skills training exercises, and a third phase involved administration of the remaining FBT components to assist in comprehensively addressing other problem areas. Results indicated most problem areas were substantially improved, but only after they were comprehensively targeted in therapy.

Concurrent Treatment of Substance Abuse, Child Neglect, Bipolar Disorder, Post-Traumatic Stress Disorder, and Domestic Violence: A Case Examination Involving Family Behavior Therapy.

High rates of co-occurrence between substance abuse and child neglect have been well documented and especially difficult to treat. As a first step in developing a comprehensive evidence-based treatment for use in this population, the present case examination underscores Family Behavior Therapy (FBT) in the treatment of a mother who evidenced Substance Dependence, child neglect, Post-Traumatic Stress Disorder, Bipolar I Disorder, and domestic violence. Utilizing psychometrically validated self-report inventories and objective urinalysis, treatment was found to result in the cessation of substance use, lower risk of child maltreatment, improved parenting attitudes and practices, and reduced instances of violence in the home. The importance of utilizing validity scales in the assessment of referrals from child welfare settings is discussed, and future directions are reported in light of the results.

Family behavior therapy for substance abuse and other associated problems: a review of its intervention components and applicability.

A comprehensive evidence-based treatment for substance abuse and other associated problems (Family Behavior Therapy) is described, including its application to both adolescents and adults across a wide range of clinical contexts (i.e., criminal justice, child welfare). Relevant to practitioners and applied clinical researchers, topic areas include its theoretical and empirical background, intervention protocols, methods of enhancing motivation for treatment, and future directions.

Description of a standardized treatment center that utilizes evidence-based clinic operations to facilitate implementation of an evidence-based treatment.

Developers of evidence-based therapies are enhancing methods of teaching therapists to implement "best practices" with integrity. However, there is a relative dearth of information available as to clinic operations and related contextual factors necessary to sustain successful implementation of these treatments. This article describes various evidence-based administrative strategies and methods utilized by clinic staff to effectively implement a comprehensive evidence-based treatment for substance abuse (i.e., Family Behavior Therapy). The basic structure of the clinic, standardized behavioral methods associated with its day-to-day operations, and maintenance of treatment integrity are delineated. Infrastructural systems are underscored, including clinical record keeping, quality assurance, and staff management.

Role playing: applications in hostage and crisis negotiation skills training.

Role playing has been a mainstay of behavioral assessment for decades. In recent years, however, this analogue strategy has also enjoyed widespread application in the field of law enforcement. Most notably, role-play procedures have become an integral component of assessment and training efforts in hostage and crisis negotiation, which attempts to resolve high-risk and often volatile situations in a peaceful, nonviolent manner when possible. The purpose of this paper is to (a) describe development and validation of a role-play test specifically geared toward law enforcement negotiators, (b) present different role-play formats that have been incorporated in law enforcement negotiation training, and (c) discuss limitations and considerations in use of these instruments. Suggestions for directions that future efforts in this area might take are offered. The heuristic value of role playing in crisis management, counterterrorism, and emergency and mass casualty disaster training exercises is also underscored.

The Law Enforcement Officer Stress Survey (LEOSS): evaluation of psychometric properties.

This study establishes the reliability and validity of the Law Enforcement Officer Stress Survey (LEOSS), a short early-warning stress-screening measure for law enforcement officers. The initial phase of LEOSS development employed the behavioral-analytic model to construct a 25-item instrument specifically geared toward evaluation of stress in this population. The purpose of the present study was to examine psychometric properties of the LEOSS. Results indicate this instrument has good levels of internal consistency, test-retest reliability, and validity. Potential applications of the LEOSS in clinical and research contexts are discussed. The next phase of research on the LEOSS is discussed, and suggestions for directions that future research in this area might take are offered.

Critical incident stress management in a mid-sized police department: a case illustration.

Pembroke Pines Police Department (PPPD), Pembroke Pines, Florida, collaborated with Nova Southeastern University (NSU), Fort Lauderdale, Florida, and the Federal Bureau of Intelligence (FBI), Miami Field Office, in the fall of 2001 to develop, train, and launch a specialized unit of crisis negotiators (Critical Response Team; CRT). The hallmark feature of the PPPD CRT was the expectation that all team members were trained in accordance with both the FBI's crisis/hostage negotiations model and the ICISF model of Critical Incident Stress Management (CISM). The deliberate result of this collaborative training provided PPPD with an "in-house" crisis response team grounded in standardized CISM principles and prepared to expand with forthcoming current best practices (e.g., peer support and specialized training) most notably Crisis Management Briefings (Malcolm, Seaton, Perera, Sheehan, & Van Hasselt, 2005; Sheehan, Everly, & Langlieb, 2004; Clark & Volkman, 2005). The purpose of this case illustration is to present the development and application of this agency's tactical execution of a police-based approach aimed at addressing the inherent CISM needs of law enforcement. Practical relevance and suggestions for future research are also discussed.

A behavioral-analytic model for assessing stress in police officers: phase I. Development of the Law Enforcement Officer Stress Survey (LEOSS).

Research and clinical reports over the past 25 years have documented the high level of stress inherent in the law enforcement profession. Further, these findings have indicated a wide range of negative physical and mental health sequelae from this stress. The present study employed a behavioral-analytic assessment approach to develop a brief, early warning screening measure of stress among law enforcement officers, the Law Enforcement Officer Stress Survey (LEOSS). This paper describes the initial phases of the LEOSS development following the behavioral-analytic method, which included situational analysis, item development, response enumeration, response evaluation, and construction of the survey. This process resulted in a final 25-item instrument specifically geared toward evaluation of stress in law enforcement officers. The next phase of research on the LEOSS, and suggestions for directions that research in this area might take, are offered.