Rosecrance Florian provides individualized treatment for firefighters, paramedics

A new substance abuse program designed specifically by and for firefighters and paramedics has launched through Rosecrance, a private, not-for-profit behavioral healthcare organization based in Rockford, Ill. Called Rosecrance Florian, the program essentially started as a grassroots movement, explains medical director Raymond Garcia, MD, because the people who needed it most approached the organization about developing it.

Rosecrance Florian has a dedicated eight-bed unit at the Rosecrance Harrison Campus, an adult treatment facility in Rockford, as well as an established board of advisers comprising fire chiefs and other leaders in the national fire department and paramedic community. After a soft launch and treating clients at around half capacity—mostly because the identified space was filled with other patients—the unit has now been remodeled and Rosecrance Florian is ready to roll.

Program director Dan DeGryse, BA, BS, CEAP, CADC, LAP/C, is an active member in the Chicago fire service community, currently holding the rank of Battalion Chief/Emergency Medical Technician in the city fire department. DeGryse also has served as coordinator of the Chicago firefighter’s union Local 2 Employee Assistance Program (EAP) for 14 years, worked as a peer supporter in New York after the Sept. 11, 2001 terrorist attacks, and has a clinical background in mental health and substance abuse.

Through his job with the EAP, he says a primary goal was to find local behavioral healthcare resources for union employees. Despite going to 96 firehouses over two years to let employees know what services they offered—in addition to the publications and posters they distributed and family events they planned—more was needed.

 “I told my staff, ‘We have a great program and great people, but no one knows about it and we don’t know about other resources—we’re not doing our jobs,’” he says. “So I started to [research] different local treatment centers and what they provided to see if I could work with a facility on individualized treatment plans. I wanted someone to understand what we see and do and feel and experience—on the job and off the job—when they come into treatment, and nobody had that.”

DeGryse was drawn to the Rosecrance Harrison Campus because it was already a well-established treatment center.

 “A lot of times you look in a facility, there’s a lot of turnover. Their leadership, staff and clinicians had all been there for a long time,” he says of Rosecrance. ”So I came to Phil Eaton, CEO of Rosecrance, and said, ‘You’ve been doing this for 43 years; I need your advice. We need a place [where] our members feel safe and feel connected.’”

The agreement was forged, and not only did DeGryse start sending people to the facility, but he also started training Rosecrance staff about firefighter culture.

Fire training
Enabling the clinicians to understand what first responders deal with on a daily basis was one of the most important precursors to an individualized treatment program, DeGryse says. Members of the clinical team, including the medical director and administrator of the facility, all went through local fire training.

 “I knew that I had to come in here and give the clinicians a little education on who we are and what we are about, but they were willing to feel the heat and see the smoke, put on the gear and feel what it’s like to drag a 160-pound dummy and struggle with that,” he says.

DeGryse adds, “That gave them a real, hands-on glimpse of why somebody might be holding on to something for 15, 20, 25 years from an event where they weren’t able to save somebody.”

Fire training especially helped the staff learn how to communicate with clients effectively, Garcia says.

“It helped us speak their language,” he says. “We got a bit of a crash course on how they communicate and that’s really important because that’s a big part of the culture for these professionals; that connection that they have and how much they rely on each other."

Suicides on the rise
On top of substance abuse, anger issues, marital issues and medication management problems that often plague firefighters and paramedics, a big issue in the community is suicide. DeGryse says there have been over 50 suicides in a 23-year period in the Chicago firefighting community. In 2008 and 2009, there were seven in 18 months alone.  DeGryse believes that the deaths were a result of substance abuse, mental health issues, undiagnosed post-traumatic stress disorder (PTSD) and lack of treatment and education.

“It was like the 800-pound gorilla in the room that no one is talking about,” he says, adding that he decided to conduct his own study after looking online and finding nothing about behavioral health in the fire service. “It really aggravated me because fire service has been around for a long time. Why isn’t there information on this? Why isn’t someone doing something about this? People always say if somebody doesn’t do it, pick up the tools and do it yourself.”

DeGryse is a member of the International Association of Firefighters (IAFF), and after talking about the suicide problems in Chicago with members from New York, Boston, Baton Rouge and Fairfax County, Va., he found that people who had years of trauma and substance abuse were the ones choosing to end their lives. 

“The average age was 55, and that boggles my mind,” he says. “That’s the time when people are retiring and should be looking at spending time with their families. But when looking at the trauma and the physiological changes over the years, it makes sense.”

Specific clinical needs

In the study he conducted, DeGryse also discovered that although the national average prevalence of heart disease is 28%, it’s 40 to 44% for Chicago firefighters.

“This is directly related to stress and how we deal with that stress,” he says. “There are physiological changes going on in our bodies that we were never aware of, so a treatment center really needs to understand the nuances of what goes on with us.”

For example, as a Battalion Chief, DeGryse doesn’t get a lot of sleep.

“When I try to lie down, I feel like my body is shaking,” he says. “I’m not physically shaking, but because of the adrenalin and the cortisol (a steroid hormone released in response to stress) my body’s on high alert because of the alarms and the stuff that’s going on.”

PTSD and substance abuse are issues that firefighters and first responders often deal with differently from other patients. Learning healthy coping mechanisms is extremely important so they can eventually be reintegrated into their careers without having to rely on substances. 

“Even though a lot of other people suffer from PTSD, what’s different about firefighters and first responders is the trauma and the day-to-day stress they experience is persistent,” Garcia says. “A lot of times people may have had one or two significant experiences that triggers their trauma and it contributes to their substance abuse problems, but for firefighters this is their bread and butter.”

 Garcia explains that traumatic situations remain part of firefighters' everyday experiences.

“This is what they see every day,” he says. “So we’re talking about not only an accumulation of traumatic experiences, but experiences that they’re going to have to continue to have when they go back to work.”

Garcia says measurements are taken when clients first present for treatment and when they leave, and improvements have been seen in anxiety symptoms and coping mechanisms.

The importance of peer support
Because fire personnel are problem solvers and pragmatic in nature, DeGryse says that when the first clients of the program arrived for treatment, many felt like they had failed. But after they sat down with him, they started to adjust. 

 “I could feel them relaxing and having a sigh of relief like, 'Oh, thank goodness there’s somebody like me that understands me, that’s going to help me,'” he says.

DeGryse says that peer support, similar to Alcoholics Anonymous (AA), is another important element in an individualized treatment program for firefighters and first responders.

“I’ve learned in the 14 years I was an EAP that there was a reason people came and talked to me—because they knew I got it,” he says. “We give people who have been through problems—recovery, mental health issues, PTSD—a level of training awareness and we use them as peer support interventionists, crisis management when people need help, much like 12-Stepping.”

The trained peers, active in an organization called the Illinois Firefighter Peer Support Team, come in, share their stories and interact with clients. 

“After every single meeting, it was like a family affair because that’s what we are in the firehouse; that’s really our second family,” DeGryse says.  

He adds, “When they trust us, they trust the clinicians that are doing the primary therapy, which is fantastic. So somebody might struggle to transition the first couple of days, but that’s it. They hit the ground running and get so much more out of treatment.”

DeGryse says every client in the program so far has wanted to participate in the peer support group post-treatment. This is particularly important because, despite answering the problems of the world, most firefighters and paramedics hide behind a “blue shield” when it comes to facing their own problems, he says.

For example, DeGryse says, an hour could go by in the firehouse as people chime in about a plumbing issue: recommendations on specific technicians and what their rates are. On the other hand, if someone asked for recommendations on a mental health clinician, you could hear a pin drop.

“That’s not how it should be,” he says. “It’s been too long that there haven’t been individualized and dedicated programs for this population.”