Supporting First Responders in Alternative Response Programs Serving Behavioral Health Crises, Addiction, and Homelessness

• In Event: Partnering for Community Resilience: Collaborative Approaches for Hazards, Emergency Management, and First Responders

Abstract

An estimated one-fifth of police calls in the U.S. involve a person experiencing a mental health or substance use crisis, and communities across the U.S. have recognized the need to shift responsibility away from police to alternative first responders. Alternative first response programs can play a critical role in responding to these crises by increasing connection to resources for people experiencing homelessness, addiction, and/or mental illness, thus reducing strain on emergency services, easing crowded hospitals, and saving cities money. Many cities rely on Fire Departments and Emergency Medical Services (EMS) to serve in these alternative first response programs. This increasing scope of work can be hard for first responders, who experience a high rate of burnout and turnover.

Through a four-year civic-partnered participatory action research study, we explored the perspectives of people serving on emergency and street-based response teams in an urban setting in northern California. After formative focus groups, we developed and piloted a slate of interventions to strengthen response programs and prevent moral injury and burnout among first responders. We also empirically assessed moral injury among these first responders though both qualitative and quantitative methods.

First responders identified a wide range of interventions, from structural systems improvement (e.g. expanded shelter hours, more treatment facilities, access to city-wide data systems) to workplace modifications (e.g. complex call debriefs, restrictions on mandatory overtime, and increased casual team-building time to build team rapport) that would enhance their ability to serve their communities while preventing burnout and moral injury. We collaboratively and iteratively piloted several interventions and evaluated them using a mixed-methods approach. Through these efforts, we developed a model for how moral injury and burnout arise among first responders using an ecosocial approach. Using a validated moral injury scale, we found that exposure to potentially morally injurious events was ubiquitous and that nearly 20% of respondents met the threshold for clinically meaningful moral injury. 

Through this partnered participatory action research study, we found moral injury is a salient concern and that modifiable structural and workplace factors are important drivers of risk. There were also challenges to using participatory methods in the context of a hierarchically structured organization designed for emergency response. We discuss lessons learned through navigating these challenges.

Author

• Miranda Worthen, San José State University
  Presenting Author