The 2nd Alarm Project: Bridging Social Work and Public Health to Improve Mental Wellness in the Fire Service.

Firefighters are trained to respond to a wide range of emergencies, and over the course of responding to emergencies, are exposed to a variety of potentially traumatic events. Repeated exposure to traumatic events may adversely impact firefighters' mental health. Combined with stigma surrounding help-seeking, lack of systematic resources and referral programs, and other barriers to care, firefighters do not routinely receive a continuum of trauma informed, assessment and treatment services from trained professionals. The purpose of this paper is to describe an evidence-informed approach to a reciprocal, collaborative model among social work and public health practice, policy, and research; and to offer a framework for researchers, clinicians, and policy advocates to more effectively achieve goals of preventing and treating trauma exposure in firefighters. This paper provides a comprehensive literature review, as well as describes a case study of a successful public health intervention for mitigating exposure to trauma among a population of firefighters. The significant contribution of mental health issues to the burden of disease among our firefighters is a matter of considerable public health concern. Effective approaches to mitigating behavioral health needs must bridge both mental health disciplines and public health to minimally, include access to evidence-based assessment and treatment, peer support capacity building, widely available mental health education, and leadership development to promote culture change. When considering a model for services with firefighters, reciprocal collaboration among researchers, health care professionals, first responder organizations, families, and other relevant community stakeholders is essential for success.

Manual development: A strategy for identifying core components of integrated health programs.

Integrated care models are gaining popularity as a clinical strategy to reduce costs and improve client outcomes; however, implementation of such complex models requires an understanding of programmatic core components essential to producing positive outcomes. To promote this understanding, evaluators can work collaboratively with organization staff and leaderships to gather information on program implementation, adaptations, organizational buy-in, and project outcomes. In 2011, SAMHSA funded two Miami health clinics to implement integrated care models in co-located settings. Changes in the federal healthcare landscape, non-Medicaid expansion for Florida, and the complexity of projects goals led evaluators to facilitate a core component review as part of evaluation. A manual was developed throughout the project and captured a description, adaptations, inputs needed, lessons learned, and sustainability for each integrated care component. To increase chances for program success, evaluators should institute a method to better define core components of new programs and implementation adaptations, while keeping program replication in mind. Breaking down the program structurally gave the evaluation utility for stakeholders, and ultimately served as a resource for organizations to better understand their program model. The manual also continues to serve as a dissemination and replication source for other providers looking to implement integrated care.