IAFF Center of Excellence Toolkit

Referrals

IAFF Center of Excellence Admissions Center 
(855) 900-8437

Richard Gallegos
Lead Admissions Coordinator

Cole Jaczko
Admissions Coordinator

For a Member in Crisis

Firefighter & Family Crisis and Support Line
(844) 525- FIRE (3473)

National Suicide Prevention Lifeline
(800) 273-8255

Crisis Services Canada 
(833) 456-4566
Text: 45645

If You Have a Member at the Center and Need Assistance

Note: Center of Excellence treatment staff cannot speak with you about a member unless the member has signed a release of information.

Will Newton
Director, IAFF Occupational and Behavioral Health Services
[email protected]
(202) 824-9303

Facility Main Number
(240) 681-6000

Abby Morris, MD
Center of Excellence Medical Director/Psychiatrist
(240) 681-6000, ext. 1211

Admission and Insurance Questions

Kelly Savage
Senior Community Outreach Coordinator
[email protected]
(904) 625-1157

Myrrhanda Jones
Community Outreach Director 
[email protected]
(352) 538-0377

Center of Excellence Call Center
(855) 900-8437

Help Finding a Clinician for Aftercare

Molly Jones
Clinical Outreach Coordinator
[email protected]
(240) 257-4838

Molly is available to provide continuing education for locals and their departments on fire fighter-focused behavioral health topics. To book a presentation, please click here to submit a request.

For a Member in Crisis

Firefighter & Family Crisis and Support Line
(844) 525- FIRE (3473)

National Suicide Prevention Lifeline
(800) 273-8255

Crisis Services Canada 
(833) 456-4566
Text: 45645

Signs That a Member Needs Help

Signs that may indicate a member is experiencing a behavioral health problem or crisis include:

• Poor work performance
• Disinterest in work or performance feedback
• Recurring mood swings or irritability
• Noticeable increase or decrease in weight or appetite
• Reported sleep problems, observable grogginess
• Recurring absences or unexcused absence
• Less talkative at kitchen table or around the fire station
• Difficulty interacting with other crew members
• Disappearing or isolating for large parts of the shift
• Crew feedback that the member seems different or is struggling
• Drastic, sudden changes in one’s living situation or relationships at home
• Recurring financial problems or debt
• Increased need for privacy around cell phone usage
• Bloodshot eyes, pinpoint pupils or alcohol odor
• Poor hygiene or noticeable changes in physical appearance
• Observed dissatisfaction, apathy or cynicism towards the job, the crew or life

Intervention 

If a member is showing any of the signs listed above, it is your responsibility to intervene. The member may just need to talk, need a few days off to deal with a family matter or may be struggling with a serious mental health or substance abuse problem that needs attention.

Your relationship with the member may dictate how you choose to intervene. Options include:

• Ask the member privately, “I’ve noticed some changes in you lately. How are you doing?”
• Ask your peer support team leader to check in with the member
• Ask another crew member who is friendly with member how they the member is doing
• Refer the member to your department clinician or EAP
• Consider referring the member for a fit-for-duty evaluation

Treatment at the Center of Excellence

Individuals typically seek residential treatment when symptom stabilization is not achieved at a lower level of outpatient care. In some cases, however, residential treatment is clinically indicated when there is no prior treatment history.

When an member’s  work, family, home or social life is severely impaired by symptoms or behavior, residential treatment may be a good choice. Residential treatment can also provide an added layer of anonymity that is difficult to achieve at a local treatment facility.

In addition, data show that IAFF members are more willing to seek treatment at the Center of Excellence compared to a general population facility. In a survey of IAFF members who were treated at the Center of Excellence, 68 percent reported they would not or probably would not have sought treatment if they could not have attended treatment in a setting exclusively for fire fighters.

Warning Signs a Member Is Suicidal

While symptoms of a behavioral health problem are not always obvious, suicide warning signs are clear behavioral, emotional or interpersonal cues that a member is at immediate risk to attempt suicide:

1. Talking about or feeling hopeless, trapped or having no reason to live
2. Talking or thinking about wanting to die
3. Talking about or feeling unbearable pain
4. Researching or planning ways to kill oneself
5. Talking about or feeling like a burden to others
6. Talking about or feeling a lack of belonging
7. Calling people to say goodbye
8. Giving away prized possessions
9. Abandoning social, occupational and daily activities
10. Severe and sudden changes in sleep, substance use, and mood

If a member is displaying any of the signs above, he/she should be escorted to a mental health provider, emergency room or accompanied during a call to an accredited crisis hotline immediately.

While an admission to the Center of Excellence can usually be facilitated within one to three days, if your member is suicidal, he or she needs immediate local medical attention. Admission to the Center of Excellence can be coordinated once the member is in a safe place.

Pre-Admission

Once a client has been accepted to the Center of Excellence, the admissions team will work with the member to schedule a date for admission, help arrange transportation, provide guidelines on what to expect and confirm financial terms.

Leading up to the member’s admission date, the team will check in daily with the member via phone to provide continued support and encouragement.

Transportation

Members are responsible for transportation costs to and from the Center of Excellence. Members can travel by plane, train, bus or car drop-off. If traveling by plane, members can fly into any of three local airports: Baltimore-Washington International (BWI), Ronald Reagan National Airport (DCA) or Dulles International Airport (IAD).

Admissions staff will collect travel arrival information. Members should book a one-way ticket as length of stay varies depending on individual treatment plans.

Arriving at the Center of Excellence

If the client is arriving via airline or train, he/she will be met at the terminal or station by the Center of Excellence driver in an IAFF-marked van, transported to the treatment facility and checked in at the Administrative Building. Upon arrival at the treatment facility, each member will complete a nursing assessment, sign treatment consent forms, and receive a body search and contraband check.

The member will then be greeted by staff and peers, who will ensure that he/she feels welcome and acclimated.

Meeting the Treatment Team

Within three days of admission, your member will receive a thorough history and physical, psychiatric evaluation, biopsychosocial assessment and group orientation to the treatment program. Your member will also be assigned to a primary individual therapist. Members can begin attending group therapy and treatment programming as soon as they are medically cleared.

During the admission period, members will also meet the Center of Excellence outreach specialist and have the opportunity to opt in to an 18-month outcome measurement and aftercare monitoring program.

What to Bring

• Insurance and pharmacy card
• Driver license/state ID
• A list of important phone numbers
• One week of season-appropriate clothing that will be laundered onsite
• Sleepwear
• One-piece swimsuits for ladies, knee-length board shorts for men
• Workout clothing and shoes
• Toothbrush, unopened toothpaste and alcohol-free mouthwash
• Unopened shampoo and conditioner
• Unopened sunscreen
• Unopened face wash and moisturizer
• Unopened lotion
• Unopened lip balm
• Unopened contact solution
• Unopened feminine products
• Positive reading material
• Pictures of family and friends
• Music device (no internet access)
• Hobby items (journals, sketchbooks, etc)
• Prescribed non-narcotic medications*
• Pre-paid credit card or cash

Contraband

The following items are not permitted and will be confiscated as contraband:

• Aerosol products
• Any item containing alcohol in the first three ingredients (e.g., perfume, cologne, mouthwash, makeup)
• Bleach and bleaching items
• Cell phones and any devices with internet capabilities
• Drug paraphernalia
• E-cigarettes and vape pens
• Electric appliances
• Flammable liquids
• Hair dye
• Keys
• Knives, guns and weapons of any kind. There is the possibility that a patient will not be admitted if in possession of these items.
• Medication or medical supplies
• Metal forks, knives and spoons
• Sexually inappropriate and drug-related materials (magazines, books, clothing)
• Essential oils
• Wire hangers
• Any consumable items (food and drink) that is homemade or pre-packaged

Contraband items will be returned at discharge.

Communicating With My Member After Admission

When your member first enters treatment, his/her focus is on recovery first and foremost. Members may or may not choose to speak with union or department officials while they are in treatment. If your member has signed a release of information (ROI) for treatment staff to communicate with you, you are welcome to call the staff for updates as needed.

Call the Center at (240) 681-6000 to leave a message for your member; staff will ensure the message is received by the client.

Please note that during the first 72 hours after admission, communication with union or department officials, friends and family is restricted.

This is a standard practice in residential psychiatric and rehabilitation facilities. The purpose of this period is to protect your member from the external stressors and distractions that can interfere with the member’s initial clinical assessment and adjustment to the treatment experience. Your member will be quickly embraced by his/her peers and a caring staff.

Phone Use

Cell phone use is a privilege and can be lost if rules are violated. All patient’s will have a 72-hour (three day) blackout period from all phone use effective upon arrival. Patients will be allowed to use a land line after beginning their clinical programming (unless a patient’s clinician or medical staff decides it might deter from treatment).

Once approved for cell phone use by their clinician or medical staff, patients will be able to use their cell phone on Mondays and two other weekdays. All privileges are subject to change. Cell phone use is to be limited to email/texting, bill paying and brief phone calls.

Deductibles

A deductible is a specific dollar amount your health insurance plan may require you to pay out of pocket toward covered health care each year before your health plan begins to pay for covered medical expenses. Annual deductibles can vary significantly from one health insurance plan to another. Deductibles must be paid up front

Co-Insurance Coverage

Co-insurance is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed. Co-insurance is a percentage payment after the deductible up to a certain limit and must be paid before any policy benefit is payable by an insurance company.

Co-Payments

Co-payments are in addition to deductibles. Some policies may include co-pays for certain days of services provided or admission to certain levels of care. These should be outlined in a plan’s benefits summary or can be provided by verifying benefits with the Center of Excellence.

Out-of-Pocket Expenses

Many health insurance plans require you to pay out-of-pocket expenses before accessing your health care benefits. Each client’s individual out-of-pocket costs varies depending on a number of factors, including:

• Plan benefits
• Length of stay
• Treatment services
• Medications and lab services
• Boarding fees – $20 per day at outpatient level of care only

Out-of-Pocket Maximum

This is the amount for all annual health care costs. Center of Excellence intake coordinators will review these fees and your financial obligation with you. Deductibles are due upon admittance. Co-pays and the out-of-pocket balance will be billed and paid after treatment once services are complete.

Transportation

Clients are responsible for transportation costs to and from the Center of Excellence. Members can travel by plane, train, bus or car drop-off. If traveling by plane, members can fly into any of three local airports: Baltimore-Washington International (BWI), Ronald Reagan National Airport (DCA) or Dulles International Airport (IAD).

Admissions staff will collect travel information and a Center of Excellence staff member will be at the airport or train station to transport the member to the Center.

Clients should book a one-way ticket as length of stay varies depending on individual treatment plans.

Boarding Fees Scholarship Program

The IAFF Foundation administers a Boarding Fees Scholarship program for all members admitted for treatment at the Center of Excellence who enter the partial hospital program and intensive out-patient program levels of care and who request to participate in the scholarship program.

Members will be informed by a Center of Excellence staff person of their right to participate in the scholarship program. The Center of Excellence provides the participating member’s medical record number to the IAFF Foundation for payment purposes only. Neither the member’s name or other identifying information is provided to the IAFF or IAFF Foundation.

Members who choose not to participate in the scholarship program are required to sign a financial obligation form that states they are responsible for the boarding fees.

Payment Plans

The Center of Excellence has options available to help members meet financial obligations, including setting up a payment plan.

The Treatment Journey

The average length of stay is between 30 and 45 days. Each treatment plan is individualized so length of stay varies depending on multiple factors, including treatment needs, progression through program, insurance coverage, time off and personal/family obligations.

Step 1 — Contact

A prospective client, family member, local member or department member can reach out to the Center of Excellence admissions department, which operates 24/7 with dedicated intake coordinators trained specifically to address IAFF members’ needs and guide them through the admissions process.

Step 2 — Insurance Verification

The intake team obtains a prospective client’s insurance information to verify benefits and determine insurance coverage for services at the Center of Excellence. The intake team can also provide a summary of benefits for an entire department’s insurance policy, which can be useful if other members are interested in treatment at a later date. The Center of Excellence has in-network contract with most major insurers. Accredited by the Joint Commission, the Center can also accept individuals whose insurance allows them to use out-of-network benefits or those looking to pay privately for treatment.

Step 3 — Pre-Assessment

The admissions team conducts an individual pre-assessment by phone, which generally takes 15-20 minutes. This information is used by the clinical team to screen for existing substance abuse and mental health issues, other medical conditions and any relevant family history. While the actual diagnostic assessment cannot occur until the member arrives at the Center of Excellence and is evaluated by clinical staff, pre-assessment information is used to determine if the Center of Excellence will be an appropriate fit for treatment and to obtain initial insurance pre-authorization.

Step 4 — Costs

Intake staff will review insurance coverage and projected costs of treatment with the member. While the exact cost of treatment cannot be determined prior to admission, members are informed of daily co-pays, deductibles and out-of-pocket maximums per their plan. Every member’s treatment experience is different, including the length of stay, level of care and potential additional costs, such as prescription needs. Incremental payment plans are available.

Step 5 — Admission

The Center will work with members to determine the best method of arrival to the facility, whether by plane, train or car. A Center staff member will meet the member at the airport or train station and transport them to the Center. After arrival, clients meet with a member of the nursing team, a general physician, psychiatrist and financial counselor.

Step 6 — Treatment

Within the first few days, clients meet with their assigned primary therapist for a diagnostic assessment to evaluate their treatment needs and develop a treatment plan to support their path to recovery. After the initial assessment, the client is placed into the appropriate level of care, depending on diagnosed primary and co-occurring conditions. During their stay, clients participate in both individual therapy, group therapy and psychoeducational group sessions. Treatment levels range from acute medical detox to intensive outpatient treatment. Clients reside in one of four station houses on the Center of Excellence campus.

Step 7 — Discharge

Discharge planning begins at the start of the treatment stay to ensure success throughout the client’s recovery journey at the Center and beyond. Upon discharge from the Center, a client will have an appointment to continue local behavioral health treatment within seven days, in addition to a follow-up appointment with a primary care doctor. The recovery process does not end upon leaving the Center of Excellence. The Center is focused on creating sustainable, long-term success.

The Treatment Experience

The average length of stay at the Center of Excellence is approximately four weeks, but varies based on individual clinical needs through five levels of care:

• Detox: 24-hour medical monitoring with dedicated nursing
• Inpatient: 24-hour psychiatric care with dedicated nursing
• Partial Hospitalization Program (PHP): Six days per week, with or without boarding
• Intensive Outpatient Program (IOP): Three to five days per week, with or without boarding
• Outpatient: twice weekly, with one individual session and one group treatment session.

While group therapy and psycho-education are the primary treatment modalities, patients are assigned to an individual therapist and receive ongoing individual therapy twice weekly during inpatient and PHP levels of care, and once weekly during the IOP level of care.

All patients receive a thorough psychiatric diagnostic evaluation and medication evaluation upon admission. When clinically indicated, family therapy sessions are scheduled with family members who choose to visit their loved one.

The Approach to Treatment

On the job and in the firehouse, fire fighters function as a highly cohesive social unit. Off the job, fire fighters are a clinically diverse patient population that requires a variety of evidence-based treatment approaches to address occupational trauma, co-occurring addiction and other complex behavioral health problems.

While roughly one-third of patients admitted to the Center of Excellence seek treatment for post-traumatic stress disorder (PTSD), other commonly treated conditions include a primary substance use disorder, major depressive disorder, complicated grief, social anxiety disorder, obsessive compulsive personality disorder and other addictions or compulsive behaviors (e.g., sex, gambling, binge eating).

Treatment approaches include cognitive behavioral therapy (cbt), cognitive processing therapy (cpt), informed therapy,  eye movement destination reprocessing (emdr), motivational interviewing, psycho-education and life skills, resiliency training, biofeedback (available offsite) and pain management.

An Inclusive Approach to Recovery

While a strong psycho-therapeutic program is the foundation of treatment, the Center of Excellence is designed to provide purposeful, goal-directed activity outside of the therapy session. Alternative wellness approaches enhance recovery by restoring a broken mind, body and spirit:

• Yoga (twice weekly)
• Alcoholics Anonymous Meetings (twice weekly)
• SMART Recovery Concepts
• IAFF Peer Fitness Training • Recreation Therapy
• Pastoral Care
• Equine Therapy (available offsite)

Comprehensive Discharge Planning

Preparing patients for successful reintegration to work, family and home life depends on continued recovery and accountability at a lower level of care.

Case managers strive to connect patients with culturally competent health care providers who understand the demands of the fire service. With patient permission, discharge treatment recommendations are shared with the patient’s outpatient clinician and fire department physician.

Discharge plans use the Wellness Recovery Action Plan (WRAP) model and include the minimum following components, including the first behavioral health appointment within seven days:

• Referral to clinically indicated level of care (intensive outpatient or outpatient)
• Individual therapist appointment
• Psychiatrist/prescriber appointment, if indicated
• Primary care appointment
• List of local resources for self-help support (AA, NA, SMART recovery groups, etc.)

A Commitment to Aftercare Support and Outcome Monitoring

The Center of Excellence is dedicated to understanding treatment efficacy, which is why we provide continuous aftercare support and monitoring for 18 months post-discharge.  Patients who choose to participate in aftercare monitoring are surveyed at repeated intervals to measure symptom stabilization, aftercare compliance, treatment recidivism and social and occupational functioning.

The 18-month aftercare process provides ongoing support following a patient’s discharge to include discharge surveys and wellness checks (via phone) at the following intervals:

• Monthly for the first three months following discharge
• Six months
• Nine months
• 12 months
• 15 months
• 18 months

Resources

Finding the Right Clinician
For additional assistance finding a clinician, contact Clinical Outreach Coordinator Molly Jones at [email protected] or (240) 257-4838.

Return to Work

The hardest part of recovery begins after the individual is discharged from treatment.

If a member of your crew is returning to the job after time off to get help, you and others may be struggling with mixed feelings and questions. What should I say or not say? Is this person really ready to be back at work? How can I help?

Regardless of the circumstances, IAFF members know the importance of being there when a brother or sister is in need.

Meet with your fire chief/administration regarding the support of the Center of Excellence and return to work efforts.

Meet with your fire department physician as relates to promoting the COE and return to work efforts (include your risk manager or workers’ comp administrator)

Resources

How to Support a Member Returning From Treatment

Workplace Safety and Insurance Board (WISB)

The IAFF, the Ontario Professional Fire Fighters Association (OPFFA) and Advanced Recovery Systems (ARS) – operator of the Center of Excellence – have established guidelines to assist Canadian members in Ontario with access to treatment at the Center.

The Workplace Safety and Insurance Board (WISB) will permit appropriate clients to seek treatment at the Center of Excellence. In order to coordinate an admission, employees or retirees must work with their treating health care professional, employer and Center of Excellence intake staff to determine program suitability.

Before a client is approved, each municipality will individually contract with ARS Executive Vice President Jon Eisenberg on financing details. He can be reached at (954) 235-3922 or [email protected].

The standard administration fee for WSIB claims (assessed as a percentage of the treatment costs) will NOT apply to the Center of Excellence, potentially yielding a lucrative cost savings for the municipality. This does not apply to lost wage benefits, for which the WSIB’s fees will be regularly assessed to the employer.

The IAFF and ARS are available to assist other provincial affiliates and their Workplace Safety And Insurance Boards to facilitate access to treatment at the Center of Excellence. Contact IAFF Director of Behavioral Health Services Will Newton at (202) 824-9303 for additional information.

Resources

Center of Excellence FAQs – Canada
WSIB Guidelines (Ontario)

Canada Action Plan on Post-Traumatic Stress Injuries

Crisis Services Canada 
(833) 456-4566
Text: 45645