Priority One, Staff Support Services, Queensland Ambulance Service. An interview with Todd Wehr, Executive Manager

Priority One is a staff support program that’s been in place since 1992. It’s a program that’s based around a peer support model, with about 200 peer support officers (PSO’s) across the state in various locations throughout Queensland. We have trained nearly 600 PSO’s during the life of the program.

Peer support officers are volunteers who undertake a five-stage selection process from which they are carefully selected.  The final stage of this process involves them undertaking a five-day live-in experiential and didactic course involving large group and small group work. The intent of the course is not just to provide them with psychological first aid but it’s about providing an environment that enables them to reflect and have a greater understanding of their own emotional reactions to trauma, stress, suicide and to loss and grief. This enables them to be more intentional about how they provide support to others and more importantly how they might look after themselves within this role.  Self-care is a major focus and as such we encourage them to stand down or have a break at any stage during their time as PSO’s. After all, they take on this role on top of everything else in their lives.

We select peer support officers across the organisation, this includes managers, emergency medical dispatchers, patient transport officers and corporate staff, some with many years of experience and some PSO’s with only a short amount. This provides options for people to choose who to speak to. We conduct two New Recruit peer support courses per year, as well as two peer support refresher courses per year. Peer support officers are invited to attend refresher training every two to three years. The format of this course also involves a mix of experiential and didactic and large and small group work, similar to the New Recruit peer support course and will concentrate on different themes but most importantly on self-care.

In each of the 15 local ambulance service areas located throughout the state, there is a peer support coordinator. This is a PSO who is selected and agrees to take on the additional role of coordinating the peer support services within their area. Once again, they do this voluntarily. We bring them down for a two-day workshop each year. Also, in each of these areas, we select an [external] Priority One counsellor to provide supervision to the peer support officers within that area.  This is an important component of looking after the peer support officers. Also included within the peer support group are PSO’s who undertake additional training and provide additional support in relation to LGBTIQ+ related issues as well as an Aboriginal and Torres Strait Islands peer support group. Priority One also make available Chaplaincy with the provision of a QAS Chaplain to be available to provide spiritual support and guidance for those who might wish to access this.

Augmenting the peer support program, we have around 65 external Priority One counsellors, located throughout the state, who are based in private practice and see QAS clients on a sessional basis. We selectively choose those people. We don’t outsource the external counselling to an Employee Assistance Program Provider like many organisations. We select them partly on the basis of their suitability to work within a trauma context, but we also want them to be able to work with a range of issues. Our staff don’t only access counselling for trauma, but a variety of work and/or non-work related issues. We want our counsellors to be versatile. It is important that they can provide evidence based practice but it’s equally as important that they are able to fit within the ambulance context, values and culture. We encourage [the counsellors] to do station visits, and meet with the local manager, so even though they are external, they are still part of the Priority One team and the broader QAS. We also hold a Counsellors’ Conference once a year, where we invite all of the external Priority One counsellors to Brisbane and provide them with information and the latest research around particular areas that are relevant to QAS. In addition to this we provide information about what’s happening within the organisation. This helps us share with them the changes and developments that are happening within the organisation that they don’t often get to see being external to the QAS. It’s important and helpful for them to understand what’s happening [in terms of] developments and shifts in culture.

Coordinating all of this we also have the internal QAS Priority One counselling team. We currently have four full time positions. This team has a mixture of mental health professionals, with three of them having worked as operational paramedics and one with an extensive experience in private practice working with a range of first responder agencies.  This mix enables the team to be able to understand the culture and organization yet also have alternate points of view.  The mix also provides people with more options. Some people who may not otherwise have accessed support may choose to access the counsellors with the paramedic background because they perceive that they might better understand their job. Others, might choose not to access the counsellors with paramedic backgrounds because they prefer to access someone without this history, and that’s ok as well. It’s about trying to give people as many options as possible.

As a team, here in Brisbane, we try to make sure we have links and relationships with all levels of the organization. This includes the Managers in different parts of the state, the peer support coordinators, the peer support supervising counsellors and of course the peer supporters in all the areas. It’s important that we maintain these relationships so that we can all work as a team. We try to ensure that there as many options for people as possible. People don’t have to access one layer of support before the other, if they choose to, they can go straight to the chaplain or a counselor or a peer support officer. They have choices and control around how they might access the service.

[We also] provide education. All new operational staff who are employed by the QAS undertake a resilience program called Finding the Silver Lining: Stress Resilience and Growth in Ambulance Practice. This program includes a four-and-a-half-hour face to face session with us, talking about stress, critical incident stress and trauma, adaptive and maladaptive coping. We also explore the neuroscience.. and the physiological responses. We also specifically focus on resilience and posttraumatic growth. The education that we provide is a salutogenic based education. We present the idea that they can actually remain, not only well, working within an ambulance context, but that they have a much greater likelihood of increased resilience and posttraumatic growth. The critical component being what they do following a potentially traumatic event. This includes adaptive or approach coping and early access to supports.  Posttraumatic growth is something that we highlight in all of our education and something that is often overlooked in the trauma context.  In addition to this face to face training, personnel receive the ‘Finding the Silver Lining: Stress Resilience and Growth in Ambulance Practice’ textbook and are required to complete a workbook and a reflective journal within the first twelve to twenty-four weeks of them starting within their careers. They are then required to take their reflective journal and workbook to one of the external psychologists to further explore and unpack. This information stays between them and does not go back to QAS education. Whatever they choose to write in their reflective journal stays confidential. This process is designed to provide them with a confidential and affirming experience with a counsellor…it breaks down some of those perceptions around what counselling is. A lot of the paramedic graduates that we have coming into the service are not only just starting in a new career, but some of them are moving out of home for the first time, most of them are moving to a new area. They are going through a whole lot of change and transition so the purpose of them accessing the counselling component of the program is not only about the jobs that they might go to or the trauma that they might experience. It’s also about what kind of social supports they have or how they are coping with independent living or paying bills. Sometimes it’s about what positive things that they might have experienced.  [This program] increases their understanding around trauma, around mental health…around coping. The hope is that they learn how to access support when they are not distressed and that they learn that it is helpful to access support early. Since the introduction of the program 5 years ago, we have seen significant increases in the number of paramedics with less than five years’ experience accessing support. We believe that this early access to support is a positive sign.

We also provide a training program to all QAS managers and supervisors. This program is called Trauma and Resilience in the Workplace: A practical guide for QAS supervisors in supporting employees. This is a one-day training program which is mandatory for any acting officer in charge and up. We offer this program every year.  The program focuses on a range of areas specific to their roles as managers. This includes their legislative and workplace health and safety responsibility for providing a psychologically safe workplace. We found that when we first started doing the training, that all of the managers were aware of their workplace health and safety responsibility around physical injuries but many did not realise that this also extended to psychological aspects. We talk to them about stress, critical incident stress, the neuroscience around trauma, anxiety, depression and suicide and what to look for and how to access additional support for their staff. Research evaluating the efficacy of the training when we first started rolling it out found that the managers had the idea that [Priority One] was for those paramedics on road, and that it wasn’t for them. The training has enabled them to recognise that access to support is also available to them, and that there are resources available to assist them in their roles. Since beginning the training in 2009 we have had an over 350 percent increase in managers accessing support for themselves as well as frequent calls from managers asking for advice in relation to their staff members. I’m also often hearing now of managers suggesting to their staff to go and access a counsellor because they did it and they found it to be helpful…it gives permission for people coming into the job now that ‘this is ok, this is part of the culture, this is part of looking after myself’.

Training and education is a big component of what we do, I think that it can have the biggest influence across the culture. I think that they key thing, however is the many interweaving layers of the Priority One Program. This has enabled a culture that recognises that supporting staff is not just the role of Priority One, it’s everybody’s role. This enables people to have the autonomy to access the resources that they need, rather than being a passive agent, so that they can have control over what happens to them. It becomes a relationship between everybody…. looking after each other.

Todd Wehr is the Executive Manager of Queensland Ambulance Service, Staff Support Services, known as Priority One.

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