A Pilot Evaluation of a Foundational Training for Behavioral Health Clinicians Serving First Responders

Background and Purpose

First responders experience elevated rates of post-traumatic stress disorder (PTSD), substance use disorders, and suicide, yet encounter barriers to culturally competent care and a shortage of trained providers. Social workers comprise a substantial share of behavioral health workforce serving this population; however, first responder mental health remains largely absent from social work education and continuing professional development. SHIELD (Supporting the Health and Wellbeing of First Responders: Integrative Education for Clinicians) is a one-day training designed to enhance clinicians’ confidence, knowledge, and professional attitudes toward serving first responders. These training courses were offered at three first responder agencies/ departments and integrated a panel presentation of diverse first responders. This pilot study aimed to: (1) assess changes in clinician confidence, knowledge, and attitudes; (2) evaluate training implementation and quality; and (3) examine whether outcomes varied by clinician type (licensed clinical social workers [LCSWs], mental health counselor/therapist, and other types of clinicians).

Methods

A single-group pre-post design with 3-month follow-up was used across three Washington State cohorts of SHIELD training (N=74). Participants completed online pre- and post-training surveys, assessing confidence in cultural competence self-efficacy (7 items), professional attitudes (4 items), knowledge of first responder mental health and confidentiality (6 items), and training quality. Follow-up surveys assessed training application and perceived impact. Linear mixed models with random intercepts examined changes in outcomes and moderation by clinician type using intent-to-treat approach. Open-ended feedback on the implementation and quality of the training was also analyzed using conventional content analysis.

Results

Significant confidence gains (b=0.51, p < .001; d=0.82) across all five cultural competence self-efficacy items (b range: 0.37-0.61, p < .001). Attitude composite scores were high at baseline and did not change significantly (b=0.12, p=.107); perceived clinical suitability improved (b=0.36, p < .001). Knowledge improved significantly (b=1.70, p < .001; d=0.68), with the largest gains in suicidality risk recognition (24.2% to 70.2%) and treatment identification (16.2% to 52.7%). Knowledge gains were larger among mental health counselors than LCSWs (p=.022), suggesting differential baseline preparation. Training quality was high (credibility: M=8.96; organization: M=8.57; engagement: M=8.42). Content analysis identified two themes: valued components included the first responder panel and occupational culture content; suggestions centered on applied demonstrations and deeper coverage of moral injury. At 3-month follow-up, 80% applied training content and 86.7% reported improved clinical competence.

Conclusions and Implications

SHIELD demonstrated preliminary efficacy, feasibility, and acceptability across diverse agency types and clinician backgrounds. The differential knowledge gap between LCSWs and mental health counselor’s points to a concrete priority: targeted first responder content in MSW curricula, field practicum partnerships with public safety agencies, and LCSW-focused continuing education through the National Association of Social Workers. These investments would expand the pool of providers available to first responders who struggle to find culturally informed care. Next steps include replication with larger, more diverse samples, a randomized controlled trial, and client- and workforce-level outcome assessment, including first responders' access to and engagement with behavioral health services, to complete the full pathway from training to population health impact.