Trauma and Healthcare Workers: A Guide for Alberta's First Responders

Healthcare work, especially for first responders in Alberta and across Canada, can be incredibly stressful. The job often puts them in tough situations that can really affect their mental health. While in the past the attention has mainly been on patients, people are now realizing that these workers need support too. Trauma-Informed Therapy (TIT) is a way to help. This article explains the main ideas behind TIT, how it’s used, and some of the challenges, especially in Alberta and the rest of Canada.

How Trauma-Informed Therapy Evolved for Healthcare Workers

TIT developed because people realized that the stress healthcare workers face goes way beyond the usual job demands. It’s about understanding that constantly seeing people suffer takes a toll.

Early Days: Recognizing the Problem

Even before recent events, people were starting to notice the issue. Studies in the late 1900s showed that healthcare workers, like those in emergency rooms and intensive care units, were experiencing Post-Traumatic Stress Disorder (PTSD) and other trauma-related problems, especially those working with PTSD in Alberta’s healthcare workers. They were at high risk. These were the first steps in identifying the problem, but more was to come.

COVID-19: Making Things Worse

The COVID-19 pandemic was a major turning point. A study showed how it made existing stressors much worse. Canadian healthcare workers dealt with packed hospitals, fear of getting sick, not enough protective gear, and seeing death and disease every day. This was not just a physical health crisis; it was a mental health emergency for those on the front lines. Healthcare workers reported soaring levels of burnout, PTSD, anxiety, and depression.

Beyond the Pandemic: Dealing with Second-Hand Trauma

The pandemic highlighted a problem that had always been there. Even before COVID-19, healthcare workers experienced something called vicarious trauma, or secondary traumatic stress. This happens from repeatedly seeing or hearing about the trauma of others, as explained by the American Psychological Association. For example, a nurse in Alberta constantly caring for accident victims, or a doctor in a Canadian city treating patients with serious illnesses, can be deeply affected over time.

Burnout: An Existing Problem

Burnout was, and still is, a big issue, adding to the mental health challenges. Even before the pandemic, many healthcare workers were experiencing burnout, see this article. Long hours, heavy workloads, the emotional stress of caring for patients, and often not enough resources, all contribute to this problem. Burnout symptoms are often similar to trauma symptoms, so it’s important to address both.

These events highlight the urgent need for support and resources designed specifically for the mental health of healthcare workers. TIT for this group isn’t just theoretical; it’s a direct response to a real and ongoing crisis.

The Basics of Trauma-Informed Therapy for Healthcare

Trauma-informed care isn’t just one type of therapy. It’s a general approach based on core principles that guide how care is given. When applied to healthcare workers, these principles need special attention.

1. Safety First:

For healthcare workers, safety means both physical and mental well-being. It’s about creating a space where they feel safe to talk about their experiences. This includes:

• Confidentiality: Making sure that conversations about their mental health are kept private.
• Support: Providing easy access to resources like counseling, peer support groups, and mental health professionals.
• Changing the Culture: Creating a workplace where mental health issues are openly discussed without fear of judgment. For instance, a hospital in Edmonton might have regular, confidential check-ins with staff, led by trained mental health professionals.

2. Building Trust:

Trust is crucial for healthcare workers to get the help they need. It’s created through:

• Honesty: Being open about available resources, treatment options, and how to get help.
• Reliability: Providing consistent support that healthcare workers can depend on.
• Clear Communication: Using simple language, avoiding technical terms, so healthcare workers feel informed and respected. For example, a mental health program for nurses across Canada might have clear communication rules and make sure information is available in both English and French.

3. Providing Choice:

Healthcare workers should never feel forced into treatment. Control is important:

• Treatment Options: Offering different types of therapy, like cognitive behavioral therapy (CBT), EMDR, or mindfulness, because people respond differently. Resources for CBT techniques for firefighters and First Responders are available.
• Setting Goals Together: Working with the healthcare worker to set treatment goals, making sure their priorities are central to the process.
• Going at Their Own Pace: Letting healthcare workers set the speed of their therapy, understanding that healing takes time. A therapist working with a doctor in rural Alberta might offer flexible scheduling and online sessions to fit the doctor’s busy schedule.

4. Working Together:

Treatment is a partnership:

• Personalized Plans: Creating treatment plans specific to the individual healthcare worker’s experiences, needs, and background.
• Making Decisions Together: Encouraging healthcare workers to actively participate in decisions about their care, making them feel heard and respected.

5. Empowerment:

The main goal is to help healthcare workers regain control:

• Teaching Skills: Providing training in coping skills, stress management, and self-care.
• Speaking Up: Helping healthcare workers advocate for their needs at work, whether it’s for better working conditions, more resources, or policy changes.
• Focusing on Self-Care: Emphasizing the importance of self-care and providing resources to help healthcare workers prioritize their well-being. A hospital in Calgary might implement required breaks and provide on-site wellness facilities, like a gym or meditation room.

6. Peer Support:

Healthcare workers often find comfort in connecting with colleagues who have similar experiences.

• Organized Groups: Providing professionally led peer support groups where healthcare workers can safely share their stories.
• Informal Networks: Encouraging informal peer support networks within healthcare settings.

7. Cultural Awareness:

Healthcare workers come from diverse backgrounds, and trauma can be experienced differently across cultures.

• Culturally Sensitive Care: Training therapists and support providers to be culturally sensitive and understand how culture affects trauma.
• Diverse Staff: Having a diverse mental health support team that reflects the diversity of the healthcare workers. A healthcare organization in Vancouver might prioritize hiring mental health professionals who speak multiple languages and have experience with diverse communities.

These principles are practical guidelines that shape how trauma-informed care is delivered. By following them, healthcare systems can create a supportive environment for their staff, leading to a stronger and healthier workforce.

Key Developments in Trauma-Informed Therapy for Healthcare Workers

The field of TIT for healthcare workers has developed over time, with specific events shaping its growth.

Early Recognition of PTSD:

Early research in the late 20th century showed that healthcare workers, especially those in high-stress jobs like emergency departments, were showing signs of PTSD. This was a major shift, moving the focus from just patient trauma to recognizing the impact on caregivers.

Specific Therapies:

New therapies were created specifically to treat trauma, including:

• Eye Movement Desensitization and Reprocessing (EMDR): This therapy helps people process traumatic memories using guided eye movements.
• Cognitive Processing Therapy (CPT): This therapy focuses on changing unhelpful thoughts and beliefs related to trauma.
• Prolonged Exposure (PE): This therapy involves gradually facing trauma-related memories, feelings, and situations.

These therapies were adapted for use with healthcare workers, recognizing their specific needs.

SAMHSA’s Framework (2014):

The Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. provided a definition of trauma and a framework for a trauma-informed approach. This framework includes the six core principles: Safety, Trustworthiness, Choice, Collaboration, Empowerment, and Peer support. This provided a common set of guidelines for using TIT in different settings.

These developments show a progression from initial awareness to creating specific treatments and a complete framework for care.

Current Trends in Trauma-Informed Therapy for Healthcare Workers

The field of TIT for healthcare workers is always evolving. New approaches and technologies are being developed to meet the challenges of the profession.

New Therapies:

Mindfulness: Mindfulness is becoming popular as a way to manage stress, improve emotional control, and increase self-awareness. As shown in this study, practices like meditation and yoga are being included in support programs for healthcare workers. These practices can help manage daily stress. A hospital in Toronto might offer weekly mindfulness sessions for its staff, led by a trained instructor.

Compassion-Focused Therapy (CFT): CFT helps healthcare workers develop self-compassion and reduce self-criticism. This is important for those experiencing burnout or moral injury – the distress from actions that go against one’s moral code.

Technology:

Telehealth: Telehealth has made it easier to access mental health care, even in rural or remote areas of Canada. Online therapy and support groups are more available, as shown in this study. This is especially important in Alberta, where remote communities may have limited access to in-person mental health services.

Mobile Apps: Many apps are designed to support mental well-being. They offer tools for stress reduction, mindfulness, and connections to peer support. These can be a convenient resource for healthcare workers, who often have limited time.

Adaptations for Specific Settings:

Emergency Rooms: Healthcare workers in emergency rooms often face immediate and intense traumatic events. Interventions include:

• Immediate Stress Reduction: Techniques to manage stress right after a traumatic event.
• Debriefing: Organized sessions, led by professionals, to help process the event and reduce long-term psychological effects.

Long-Term Care Facilities: Long-term care has unique challenges. Healthcare workers often develop close relationships with residents, leading to grief and loss when residents pass away. Support programs address:

• Compassion Fatigue: The emotional exhaustion from long-term exposure to suffering.
• Grief and Loss Support: Resources and counseling to help healthcare workers cope with resident deaths.

These trends show an ongoing effort to improve TIT for healthcare workers. They reflect a commitment to finding new and effective ways to support their mental health, adapting to the changing healthcare landscape.

Ongoing Questions in Trauma-Informed Therapy for Healthcare Workers

While people agree on the importance of TIT for healthcare workers, there are ongoing discussions and debates.

1. Measuring Effectiveness:

Research shows that TIT interventions generally work. However, there are ongoing discussions about:

• Specific Therapies: Which therapies work best for different types of trauma? For example, is EMDR better than CPT for healthcare workers who have experienced a specific kind of event?
• Individual Needs: How can interventions be tailored to meet the different needs of individual healthcare workers, considering their background, past trauma, and preferences?
• Long-Term Results: More research is needed on the long-term benefits of TIT. Does it lead to lasting improvements in mental health, reduced burnout, and better job satisfaction?

2. Implementation Challenges:

Bringing TIT to real-world healthcare settings can be difficult:

• Cost and Resources: Implementing TIT programs requires money for training staff, hiring mental health professionals, and developing resources. Healthcare systems, often with limited budgets, may struggle to find enough funds.
• Stigma: The stigma around mental health is still a big barrier. Healthcare workers may be hesitant to seek help, fearing judgment or career impact.
• Time: Healthcare workers, especially in Canada’s often understaffed system, have limited time. Finding time for therapy or support groups can be a major obstacle.
• Systemic Issues: Many stressors that contribute to healthcare worker trauma are systemic, like understaffing, long hours, and lack of resources. While TIT can help individuals cope, these underlying issues also need to be addressed.

3. Ethical Considerations:

Ethical issues are central to TIT:

• Patient Privacy: Supporting healthcare workers may involve discussing traumatic events they’ve witnessed, which might involve patients. Balancing support for the worker with protecting patient privacy is important.
• Healthcare Worker Confidentiality: Ensuring the confidentiality of healthcare workers who seek help is crucial. A safe and trusting environment requires strict confidentiality.

These ongoing discussions highlight the need to continually evaluate and improve TIT programs, address challenges, and maintain high ethical standards to provide the best possible support for healthcare workers.

If you are a First Responder in Alberta and need support, contact Responders First. We can provide immediate support and assist in connecting with long-term supports.

Don Davis

15+ years of emergency response experience. Passionate about connecting our first responder communities with critical resources. Author of hundreds of articles and guides on First Responders mental health care. When not responding to emergencies, you can find me playing with my dogs, hiking, or enjoying a good book.