Case study: How Halifax Fire Service manages employee stress

The Halifax Fire Service peer-to-peer program provides in-house relief from work- and home-related stress

Firefighters are trained to be a tough lot, but being emergency responders— rushing in when everyone else is rushing out—can take its toll.

To make sure challenges in the line of duty don’t emotionally scar the firefighters, the Halifax Fire Service has implemented a peer-to-peer program in partnership with the Firefighters and Family Assistance Program.

The peer support program is preventative in nature, encouraging workers to seek assistance in the early stages of a problem or crisis. As the name suggests, it provides peer support teams of firefighters who are trained to listen effectively, conduct post-incident defusings and debriefings, and make referrals to other available resources. These teams act as first responders when it comes to stress and other behavioural health issues.

The peer support team members are not psychologists, and they don’t do formal counselling. But they do provide a supportive, trusted and confidential environment for firefighters to vent or to discuss serious issues.

In many instances, the team members have been in similar situations and can offer an empathetic and experienced ear. More importantly, they help others to navigate the system and access relevant resources, such as an in-house psychologist, the employee assistance program, support groups or medical care.

According to Chris Camp, chair of the Halifax Professional Firefighters Benefits Trust, whenever there’s an incident involving death or devastation, members of the support team talk to the personnel who were present during the incident to see if they need any help.

“A lot of our firefighters take it especially hard when children are involved in a tragedy,” says Camp. “It weighs on them.”

Camp says the one-on-one nature of the program allows real people, in real time, to look each other in the eye and have a heart-to-heart about what’s troubling them. “It’s hard to read body language over the phone,” he explains. “And when people are under stress, their comprehension levels drop drastically. You can talk to them over the phone, but they may not grasp or register [what you’re saying].”

Beyond Work
The peer support program is available to the firefighters’ families as well. “We focus on the whole family unit,” Camp says. “After all, family stress can carry over to work.”

Since stressors extend beyond the job, there is also 24-7 support for a whole gamut of issues: marital discord, illness, alcohol or drug abuse—even wayward kids.

As part of this inclusive initiative, the benefits trust has enlisted a local mental health organization to survey the Halifax firefighters and their spouses. In fact, it has designed an electronic survey specifically for spouses—“Just so we have a fuller grasp of underlying issues impacting our personnel and can design specific programs around those issues,” Camp adds.

The trust is currently designing a Facebook page and website exclusively for spouses, with each entitled to a personal login and password so they feel like an integral part of the program. The department also plans to create a spouse peer referral network so that spouses feel equally supported.

Since its inception seven years ago, there have been more than a thousand referrals to professional services, as well as many more meetings conducted by the peer referral agents for individuals who didn’t require a referral—just a sympathetic ear. “In fact, the focus on early intervention means peer agents don’t always have to refer people; [they] can occasionally avert services altogether,” Camp says. “As a result of our sustained efforts in this area, there have been very few claims for extended periods of time off.”

In an effort to break the taboo around mental illness and encourage more people to seek help, employee newsletters include regular articles about mental illness.

Also, the firefighters’ benefits plan recently turned its attention to supporting employees who are taking antidepressants, in partnership with pharmacists at local Sobeys and Lawtons pharmacies. For new prescriptions, pharmacists follow up within two weeks to help employees manage any side effects or, if necessary, recommend medication or dose adjustments. They then reach out every one to three months as needed to offer ongoing support and referrals.

Heart Healthy
With their gruelling physical and mental challenges, the No. 1 cause of line-of-duty death among firefighters is heart disease. While trained peers look out for the emotional well-being of their colleagues, the Halifax Firefighters Benefits Trust also has other programs to support a healthy heart.

Every year, trained personnel conduct a week-long Healthy Heart Program. Crews are checked for blood pressure, cholesterol and blood sugar—the three key indicators of heart disease. They receive keepsake readings on a wallet-sized card. Camp says many are so engaged in the program that they save these cards to compare their readings year over year.

The results speak for themselves. In three years, the number of cardiovascular drugs prescribed to plan members dropped by 20%: from 1,301 in 2009 to 1,045 in 2012. In dollar terms, this marked a sizable $30,888 reduction in drug costs—from $107,729 in 2009 down to $76,841 in 2012.

Given the nature of their back- breaking work, firefighters will soon have access to a healthy back program where they will receive one-on-one fitness training from American Council of Exercise-certified peer fitness trainers.

Since firefighters have 24-hour shifts, they literally make the station their second home—what they jokingly call “house arrest.” They cook, eat, train and live together.

To capitalize on this captive audience—which enjoys well-cooked meals—the benefits program also invites a trained chef (the widely travelled Aldo Vidalli, whose resumé includes cooking for the Rolling Stones) once a month to teach them how to cook tasty meals without compromising their health. As a result, the firefighters’ meals are getting progressively leaner and greener.

Plain Language
As far as keeping employees informed of health and benefits information, Camp says the Halifax Professional Firefighters Benefits Trust goes “old-school”—it does not send out too many emails.

“People tend to overlook mass emails,” he explains. “They are much more likely to pick up a newsletter and read it around the coffee table or at the work sites.”

Currently, the trust is developing websites specifically for plan members. “They will be password-protected, and members can log in to see their benefits,” Camp adds.

The main aim of all of these varied benefits is to extend a sense of holistic well-being to the firefighters by focusing on their mental, emotional, physical and nutritional health.

“As a plan sponsor, we worry about our people,” Camp says. “Once the people are healthy, the bottom line takes care of itself.”

Chris Camp explains how the Halifax firefighters’ benefits program has evolved

Why did the Halifax Fire Service opt out of the city’s existing benefits plan?

Ten years ago, the Halifax Professional Firefighters was riddled with bad claims history and facing a double-digit premium increase. We established a board of trustees and embraced an ASO [administrative services only] plan for greater control over our plan design and dollars paid out.

We moved our drug plan to a pharmacy benefits manager. We also adopted a managed formulary process and a preferred provider solution for pay-direct drug benefits.

Initially, our decision to move to a preferred pharmacy network was a tough sell. People resented being told which pharmacies to go to. We explained to the skeptics that the success of this program relied on everyone participating; otherwise, we would inevitably see premium increases. That triggered a quick buy-in.

We phased in the plan with a $10 drug card at preferred pharmacies (employees pay $10 upfront; the rest is paid for by the drug plan). Those who didn’t shop at the preferred pharmacies had to wait for reimbursement. Dispensing fees were also capped. Later, we added a provision to reimburse employees only for the amount a drug cost at a preferred pharmacy.

To ensure full buy-in, we also offered a scholarship program for children of our employees. It was contingent on plan members participating in specific programs such as nutrition sessions offered by the trust or plan members submitting for recognition of self- directed activities. So far, we’ve been able to offer more than $100,000 in scholarships—more than 10 scholarships annually, worth about $2,000 each.

After eight years of no premium increases and considerable incentives, employees are now happy with the decision. Participation remains high, at 92%.

Kanupriya Vashisht is a freelance writer based in Milton, Ont.

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