Firefighters Accessing Care for Trauma: A Clinical Case Series of Distance NET for PTSD/I Symptoms

Firefighters Accessing Care for Trauma: A Clinical Case Series Testing the Efficacy of Distance-Delivered Narrative Exposure Therapy in Reducing PTSD/I Symptoms

Repeated exposure to trauma is an unavoidable part of the job for firefighters. Because of this, many Canadian firefighters screen positive for posttraumatic stress disorder/injury (PTSD/I). Unfortunately, like the general population, firefighters face many barriers to accessing mental health care. As a result, additional efforts are needed to increase timely access to effective PTSD/I services that are delivered in a way that reduces confidentiality and stigma risk. This research study will test the preliminary efficacy and feasibility of distance-delivered Narrative Exposure Therapy (NET) delivered by a paraprofessional for firefighters with PTSD/I. NET is an evidence-based intervention approach developed specifically for PTSD/I resulting from repeated and continuous trauma. The intervention will be conducted via videoconference with a trained paraprofessional supervised by a clinical psychologist. The NET intervention will consist of 12 weekly 90-minute videoconference sessions. Approximately 25 firefighters will be recruited to participate in the study. To test the efficacy of the intervention, participants will complete self-report questionnaires about PTSD/I and other mental health symptoms pre- and post-intervention as well as two- and six-months following intervention completion. Participants will also complete an open-ended interview at the end of the intervention to assess feasibility and participant satisfaction.

One-on-one intervention delivered by a paraprofessional; 12 weekly videoconference sessions at 90 minutes.

Health service use will be measured using a series of questions regarding participant's use of health services as well as frequency and intensity of service use

Intervention adherence will be measured via attendance records of participants kept by their coach. These attendance records will be used to measure the average number of completed sessions and the percentage of participants who did not complete the intervention.

Intervention perceptions and satisfaction will be measured via open-ended questions administered through a post-intervention interview

Inclusion Criteria: Participants must meet the following criteria to be eligible to move on to Consent Be at least 19 years of age Be able to understand spoken and written English at a Grade 8 level Be employed, or have been employed, by the fire service or be current or past fire service volunteers. Fulfill the criteria of full or subclinical PTSD/I according to the PCL-5. Have access to a computer with Internet. Live in Atlantic Canada or Ontario. Consent to be audio- (for consent and interview) and video-recorded (for intervention sessions). Exclusion Criteria: Having a psychotropic medication change in the past three weeks. Are currently engaged in or have previously been engaged in exposure therapy for PTSD/I. Meet criteria for current mania or psychosis. Endorse suicidal ideation with plan or intent. Experience high levels of dissociation (as assessed by a score of >18.5 on the Shutdown Dissociation Scale).