Mobilizing Behavior Change to Promote Occupational Health and Wellness Among Firefighters

Sponsor/Type: Dept. of Homeland Security/Federal Emergency Management Agency (FEMA)
Project Period: 09/09/2022 - 09/08/2024


Firefighter health and safety is a widely recognized, high priority concern. Many programs target specific risk areas, such as cardiovascular disease, cancer, behavioral health, and injury, but many are highly segmented and compartmentalized. What these priority areas share in common is that front-line preventative measures are directly dependent on behavior change relating to activity, sleep, diet, social engagement, and alcohol intake. Over the past decade, our team has partnered with firefighters and fire service leaders to develop a suite of freely available resources to enhance firefighter behavioral health. Whereas our programs have tended to focus on more typical behavioral health issues, a key ingredient is that they are characterized by motivating and mobilizing behavior change. This proposal seeks to extend this emphasis across all types of occupational health and wellness programming via a strategy of outreach tools, peer modeling, provider resources, and telehealth support.

Program Description

The Center for Firefighter Behavioral Health at MUSC specializes in creating and launching freely accessible, online resources to improve firefighter behavioral health. Our team combines decades of clinical experience with cutting edge technological expertise to overcome common barriers to access, availability, quality, and acceptability of professional care and personal support. Our suite of mobile apps and web-based resources at houses resources to help officers, peers, family members, and friends support firefighter behavioral health in areas ranging from substance abuse to suicide, and includes tools to help firefighters overcome their resistance to help seeking and finding their way to the help they need with providers who understand firefighter culture.

Helping Heroes, launched in 2012, and revised in 2021 to include additional resources, provides training in evidence-based treatments for common behavioral health conditions and is specifically adapted for firefighters. It has been used by over 10,000 practicing clinicians and has substantially expanded the pool of prepared providers available to help our nation’s first responders. Our partnership with the Employee Assistance Professionals Association extends both its scope and its reach to promote fire service expertise in the EAPs who serve fire departments. Extensive evaluation studies have shown these products to be very effective in achieving their objectives.

We have maintained an ongoing partnership with the National Fallen Firefighters Foundation, the First Responder Center for Excellence, and a range of other fire service organizations to continuously assess obstacles to access and support, and to identify the specific areas in which we can leverage technology to design and implement innovative solutions. Telehealth approaches, which our team has helped to develop and optimize in other health care domains (e.g., burn-injured patients, traumatic injury patients), rapidly took root in behavioral health care during the extended period of COVID restrictions and have demonstrated utility in both overcoming logistical barriers to accessing and providing a highly personalized way of receiving care that helps reduce concerns related to perceived stigma and confidentiality.

Broadening the knowledge and resources provided in these platforms to physical wellness (exercise, sleep, diet, social engagement, substance use, mental health) and emotional wellness (stress management, burnout, social support) could provide a revolutionary leap in promoting general and much needed wellness activities to firefighters and departments across the nation. We have the skills and capabilities to create this capacity; we are asking for the resources we need to put it into motion.

Studies examining successful health and wellness programs have recommended that programs include physical health components combined with wellness and education, although no specific recommendations have been made regarding necessary components. Our team routinely engages key stakeholders throughout the process of developing new health and wellness resources with other populations (e.g., victims of mass violence incidents, individuals experiencing COVID-related stress), and we have extensively partnered with fire service professionals in development of our existing resources at We will continue to actively engage firefighters and departments in consultation to guide our decisions around the best ways to deliver this new content and maximize its usability. The essential elements are described in detail below (see 6b).

We propose to refine and expand our highly successful platforms to include new components and activities that address physical wellness (exercise, sleep, diet, social engagement, substance use) and emotional wellness (stress management, burnout, social support). The tools will contain a series of interactive activities and will be designed specifically to help firefighters identify needs related to physical and emotional wellness, set short- and long-term goals, track and practice between-session activities and progress toward goals, and engage in check-ups. Within each of the physical and emotional wellness components, the activities will utilize education, motivational interviewing, and behavioral activation techniques to deliver the information and resources focused on improving wellness.

All of these components will be built on platforms our team has successfully implemented in related settings (e.g., telehealth outreach, disaster response, military health) and will be guided by both our substantial evaluation studies on prior work and will employ multistage focus group input through our ongoing partnerships with NFFF, FRCE, and other first responder groups, following strategies that have proven successful throughout our earlier FPS projects.

For more information contact
Tatiana M. Davidson