The growing recognition of post-traumatic stress injuries (PTSI) among police, fire and paramedic services has brought to the forefront the importance of providing support. In response, organizations are developing programs to help first responders manage or treat their symptoms, recover from their injuries and return to work.
But program implementation can be a challenge for organizations. Understanding why these challenges arise was explored in a new Institute for Work & Health (IWH) study conducted by Dr. Dwyane Van Eerd, IWH scientist, in Alberta. The study, now published in Disability & Rehabilitation (doi:10.1080/09638288.2026.2667689), found six ingredients to successful implementation. These are: getting organizational buy-in, collaborating with program champions, building awareness, ensuring adequate resources, planning ahead, and allowing for flexibility.
The study team interviewed 20 participants from Alberta police, fire, and paramedic organizations of varying sizes, regions and rural /urban settings who were selected if they had knowledge of PTSI program implementation. They included supervisors, managers, and professionals with disability management or occupational health and safety expertise. Participants were asked about their experiences related to implementation in their organizations, including barriers, facilitators and key lessons.
At participants’ organizations, several types of programs were in place or, in most instances, being planned. The programs included those that focused on peer support, critical stress management, mental health, resilience, family support and general health and wellness.
Participants noted that it was difficult to find evidence-informed programs specifically for PTSI. Some reported frustration with having to abandon programs—whether due to a lack of sustained funding or a lack of fit with a first responder culture, or a lack of uptake. Moreover, participants expressed challenges with finding information about how to implement such programs.
Study highlights experiences around program implementation across six themes
From the interviews, the team identified six key themes related to barriers and facilitators that participants encountered when implementing PTSI programs, and how to work around them:
Getting buy-in first
The team often heard about the importance of getting buy-in—from front-line service members to senior leaders. Buy-in at high levels of the organization entails not just program approval but promotion by senior leaders to service members; buy-in at the employee level means engagement and uptake. Sharing members’ success stories and positive experiences with the program is one strategy to improve buy-in across different groups, the study team also heard.
Collaborating and having program champions
Although many participants noted a preference to work in small teams during program development (for speed and efficiency), they also spoke of the need to collaborate and involve program champions to build trust in, and awareness of, the programs. Participants also highlighted the need to involve workers with diverse personalities and perspectives so that the program can resonate broadly across the organization.
Building awareness about psychological injuries
Another topic mentioned by participants was the need to continue building awareness about psychological injuries and the mental health needs of first responders, including exposures to trauma they experience. Though participants noted that awareness is growing within first responder organizations, they believe there is still work to be done—not just in first responder organizations, but also with municipalities that play a role in allocating mental health resources, as well as among health-care providers.
Ensuring adequate resources
Participants also noted that developing, delivering and maintaining programs required a variety of ongoing resources. These include confidential spaces, staff and training for program delivery. The researchers also heard about the need to report tangible impacts of the program to secure necessary resources—and about barriers to such reporting. These can include the time requirements to evaluate the program, as well as confidentiality concerns about the information that can be shared about who is using the program.
Planning ahead
Interviewees noted that planning was an important but sometimes overlooked task that should come before developing and delivering a PTSI program. Some noted the planning phase is hard to get out of, while others noted that the nature of first responder work—and the sense of urgency some feel about the need to support members who experience trauma—made them want to jump right in and implement a program without enough planning. They stressed that planning helps predict potential programming gaps, allow for program flexibility, anticipate new issues, and identify future resource needs—all of which are crucial for more effective and suitable programming.
Recognizing that one-size does not fit all
Lastly, participants highlighted the need to consider the breadth and flexibility .of program content, as well as staff expertise to deliver programming to address the diverse needs of members. They noted that existing programs would likely need to be tailored to better meet individual members’ specific or changing needs and circumstances.
How can PTSI program implementation be improved?
Overall, participants acknowledged that there is a need for more attention and practical guidance to implement PTSI programs for first responders.
Mental health professionals, researchers and occupational health and safety consultants with implementation experience could work with first responder organizations to help implement these programs,
says Van Eerd. They may also be able to help evaluate programs and implementation, while maintaining confidentiality and anonymity of program users.” As for what first responder organizations can do, Van Eerd points to a practical implementation strategies resource based on the findings from this study.
With this study, we hoped to learn what went well, and what might need more focus when implementing these programs,
he says. Organizations need more guidance on program implementation. So, with the resource, we’re aiming to help other jurisdictions and first responder organizations to think about implementation steps and processes to consider while planning, implementing (delivering) and maintaining the programs.
Download the resource for free, here: https://www.iwh.on.ca/tools-and-guides/implementation-strategies-for-post-traumatic-stress-injury-ptsi-programs-in-first-responder-workplaces