New research shows police, fire and EMS rapidly adopting supports, but struggling with planning, resources, and delivery
Post-traumatic stress injuries (PTSI) are driving a wave of new mental health programs across Alberta’s first responder agencies, but organizations are still grappling with how best to implement and sustain these initiatives, according to new research presented by the Institute for Work & Health (IWH).
In a January 27 webinar, “Understanding PTSI program implementation processes in Alberta first responder organizations,” IWH scientist Dr. Dwayne Van Eerd outlined findings from semi-structured interviews with 20 key informants involved in rolling out PTSI-related programs in fire, police and paramedic services across the province. The project was funded through the Alberta Supporting Psychological Health in First Responders grant and conducted in collaboration with the University of Alberta and Wayfound.
Growing recognition, modest evidence – but urgent need
Van Eerd says PTSI remains a “considerable burden” not only for first responders but also for their families, workplaces and society. While the scientific evidence on the effectiveness of PTSI interventions is “modest at best” and largely rooted in clinical rather than workplace studies, organizations are moving ahead out of necessity, he noted.
A previous project by the team had already flagged implementation as a major challenge for first responder workplaces. The new study focuses squarely on that implementation experience: how programs are introduced, adapted and maintained on the ground.
Programs ranged from critical incident stress management and peer support to broader mental health and wellness initiatives, as well as family-focused offerings such as “Rebuilding Families.” Many organizations had tried multiple approaches, dropping or modifying programs perceived as a poor fit for their workforce.
Six themes shaping PTSI program implementation
From the interviews, the research team identified six recurring themes “related to implementation experiences”: getting buy-in first, collaborating and champions, ongoing awareness building, ensuring adequate resources, importance of planning, and the recognition that one size does not fit all.
Buy-in emerged as foundational. While senior leadership approval was described as critical to getting initiatives off the ground, participants also stressed the need for endorsement from front-line members, including those with lived experience of PTSI.
A second theme was the role of collaboration and champions. Many organizations relied on trusted peers—often with lived experience—to advocate for programs, answer questions and normalize help-seeking. One participant described “an army of champions” whose informal outreach reduced the need for a traditional marketing strategy.
Ongoing awareness building within organizations and at the municipal or provincial level was another consistent need, particularly where broader corporate structures did not fully understand the “constant trauma that first responders are exposed to.” This broader awareness was closely linked to resourcing decisions.
Adequate resources—especially staffing and facilitator capacity—were a persistent pressure point. Several informants were implementing programs “off the side of their desk,” in addition to their regular operational duties. As demand grew, teams struggled to scale training and delivery without overextending key personnel.
Planning was widely acknowledged as important but often truncated. Many teams rushed to develop and deliver programs in response to urgent need, only to circle back later to address gaps in fit, capacity and logistics.
Finally, agencies highlighted the need for flexibility in both program content and delivery. Varied and evolving member needs, and the sensitivity of PTSI, meant rigid protocols often had to be adjusted in practice. As one participant put it, “It’s hard to be writing the perfect flow process.”
Three phases: planning, delivery and maintenance
Using the PRISM model and the Quality Implementation Framework as guides, the team mapped common experiences across three broad phases: planning, implementation/delivery and maintenance.
Planning typically began with securing buy-in, then forming small teams of credible people—often champions with lived experience—to conduct largely informal assessments of needs and fit. Formal assessment of organizational capacity was rare, leading to “discovery” of resource constraints later in implementation.
In the delivery phase, organizations focused on getting programs to members quickly, with limited use of written implementation plans or timelines. As uptake increased—helped by champion-led communication—staffing and training pressures intensified, sending teams back to rework earlier planning assumptions.
Maintenance brought its own set of challenges. Agencies faced repeated demands to demonstrate that programs were being used and were effective, yet many felt ill-equipped to conduct formal evaluations and were wary of compromising confidentiality, especially around mental health.
Implications for health and safety leaders
For health and safety leaders in first responder and other high-risk sectors, Van Eerd’s message was twofold. First, there is encouraging momentum: “many Alberta first responder organizations were developing and implementing PTSI programs,” often in the context of improving organizational cultures more open to discussing mental health.
Second, implementation quality matters. Even promising programs “can suffer when it’s not implemented well” if workers cannot access or fully use them. For leaders, that translates into investing early in structured planning, realistic resourcing, champion networks, evaluation capacity and flexible delivery models tailored to their own organizational context.
This article is part of our Monthly Spotlight series, which in February focuses on Psychological Safety & Mental Health.
