4. Discussion
depression, traumatic, post-traumatic stress symptoms, anxiety
FIRE
In general, the SFA program trainings were well received with the majority of participants in the peer team training and taking the online trainings reporting high levels of satisfaction and increased interest in the topic. Most notably, there were statistically significant findings related to questions about how prepared the department was to provide support for firefighters experiencing behavioral health issues, how well-trained personnel within the department were to handle behavioral health issues, and how confident firefighters were in the skills and knowledge of their company officers to handle behavioral health issues. These findings indicate success in the training implementation improving the department environment related to behavioral health response.Another noteworthy finding was the challenge the team had in accessing and engaging the EAP programs to implement trainings specific to first responders. Past research has found that EAP programs often have low rates or utilization [Changes in behavioral health outcomes over the 12-month intervention period were in the expected direction with scores in post-traumatic stress symptoms, depression, anxiety, and occupational stress decreasing and scores on resilience, coping self-efficacy, and emotional support improving, although the changes were not statistically significant. It is not surprising that changes were not larger with the short follow-up, given the observation period after program implementation was less than one year, because none of the departments were able to fully have their programs up and running right away. Typically, it took departments the first 6 months of the year to implement SFA within their department. However, the fact that the differences among these outcomes were clearly and consistently observed across domains is promising, particularly given that there is limited evidence for the effectiveness of any early supportive interventions for those who are not exhibiting significant symptoms. Given past research about the iatrogenic results of previously implemented, single-session debriefing programs [As with any study, limitations to the present work exist. For instance, questions about knowledge of content areas covered within the trainings were not assessed in the year prior to implementation. Rather, perceptions of knowledge were all assessed after trainings were completed, which could have resulted in a response bias. However, results complement and mirror the longitudinally assessed domains related to perceived support within the department. There are also limitations introduced by varying participation, due to scheduling conflicts or participant attrition. While the one-year implementation was proposed for logistic and budget reasons, it became clear that the timeline for implementation of a program is significantly longer than one year. Future research should focus on long-term outcomes (e.g., changes in mental health outcomes, increases in knowledge and confidence) not only at one year, but the extended impact beyond initial training. Additionally, regular follow-up support and refresher trainings would likely improve long-term outcomes.There are a number of personal and occupational factors that have been found to impact firefighters’ mental and behavioral health. These factors vary from person to person but may include chronic and acute traumatic experiences, physical demands, shift work, sleep disruption, cumulative stress, organizational stressors, family/home life stress, etc. [Interventions designed to support the mental and behavioral health of firefighters are crucial for maintaining their wellbeing. Practical implications of this work should include efforts to further reduce the stigma associated with mental health support; additional research examining training materials designed to help firefighters recognize signs of stress, burnout, or mental health issues; increased access to mental health services; access to peer support services; coping/resilience training; and leadership support. By implementing these measures and with continued research and development, fire departments can improve the behavioral health of their firefighters and create a more supportive and resilient workforce.