Heidi Cramm

Queen's University | QueensU · School of Rehabilitation Therapy

Purpose The nature and cumulative occupational demands imposed on families of public safety personnel (PSP) are substantial, in many cases non-negotiable, and distinct from the general population accentuating risk factors for family well-being. Despite this reality, the contributions of PSP families are not well understood, and a conceptual framewo...

LAY SUMMARY Infrastructure to support the educational experiences of children and youth living in Canadian military families has ebbed and flowed over time. With the launch of initiatives, such as Seamless Canada, in recent years and the recent restructuring of support infrastructure in the Department of National Defence, it appears that the educat...

LAY SUMMARY The focus of this study was on family and community. Interviews with 23 adult children of Canadian Armed Forces Veterans who served between the Korean War and the Gulf War suggested key capabilities were developed that supported them in meeting demands and contributed to adaptation over the course of their lives. Living on military base...

LAY SUMMARY Public safety personnel (PSP) families face unique challenges tied to the job’s occupational risks and requirements. These challenges can often spill over into home life, affecting the day-to-day unfolding of schedules, sleep, mood, activities, and relationships. The impact of this spillover into family life has not received much attent...

LAY SUMMARY Parents of Veterans are often excluded from literature or programs surrounding military and Veteran families. Parents can play an important role in their adult child’s life following an operational stress injury. Little research has been done to look at how supporting an adult child may affect the parents. Parents of Canadian Armed Forc...

LAY SUMMARY Preventing suicide in military communities is a priority for many countries. Families are important to understanding and addressing many health issues; a budding area of research is beginning to consider how families matter to suicide among military communities. Here, the authors describe findings from their own research projects, along...

Purpose Public safety personnel, including first responders, are regularly exposed to physical, social, and psychological risks and occupational requirements. These risks and requirements extend beyond the employee and may also impact the families (for example, work-family conflict, compassion fatigue). Despite recent attention directed at the popu...

Objectives Emergency departments (EDs) are a vital part of healthcare systems, at times acting as a gateway to community-based mental health (MH) services. This may be particularly true for veterans of the Royal Canadian Mounted Police who were released prior to 2013 and the Canadian Armed Forces, as these individuals transition from federal to pro...

Introduction Airport firefighters are responsible for providing emergency responses to aviation incidents on a runway or in the vicinity of an airport, including airplane crashes, mass casualty events, emergency landings and many other concerns on airport grounds. While data exist on the occupational stressors of firefighters and public safety pers...

Introduction Les pompiers d’aéroport ont la responsabilité de fournir des services d’intervention d’urgence en cas d’incidents aéronautiques sur une piste d’atterrissage ou à proximité d’un aéroport, que ce soit en cas d’écrasement d’avion, d’incident faisant un grand nombre de victimes, d’atterrissage d’urgence ou de nombreux autres problèmes surv...

Background Spouses and significant others (SSOs) of public safety personnel (PSP) are affected by the risks and requirements of these occupations. Internet-delivered cognitive behavioral therapy (ICBT) provides a convenient and accessible treatment format that can be tailored to the needs of SSOs of PSP. Objective This study aimed to assess the in...

LAY SUMMARY On leaving the military, Canadian Armed Forces Veterans begin receiving health care services in the civilian community. Health care providers may not understand the military culture from which Veterans come, and how military service can affect health and well-being. The purpose of this study was to identify what civilian health care pro...

LAY SUMMARY How Veterans use the emergency department (ED) after they leave the military could signal unmet health needs or health crises. Describing patterns of ED use could inform health policy to better support Veterans during military service or design programs and services for them after they leave. ED visit records from Ontario were used to c...

BACKGROUND Spouses and significant others (SSOs) of public safety personnel (PSP) are affected by the risks and requirements of these occupations. Internet-delivered cognitive behavioral therapy (ICBT) provides a convenient and accessible treatment format that can be tailored to the needs of SSOs of PSP. OBJECTIVE This study aimed to assess the in...

Firefighters are at increased risk for developing posttraumatic stress disorder (PTSD) and face numerous barriers to accessing mental health care. Innovative ways to increase access to evidence-based interventions are needed. This study was a case series testing the acceptability, feasibility, and preliminary effectiveness of a paraprofessional-del...

Introduction The study objective was to compare the mental health and risk-taking behaviour of Canadian youth in military-connected families to those not in military-connected families in a contemporary sample. We hypothesized that youth in military-connected families have worse mental health, lower life satisfaction and greater engagement in risk-...

Introduction L’objectif de l’étude était de comparer la santé mentale et les comportements à risque de jeunes Canadiens de familles liées au milieu militaire (« familles de militaires ») et de jeunes Canadiens de familles de civils au sein d’un échantillon récent. Nous avons émis l’hypothèse que les jeunes de familles de militaires auraient une moi...

Family are influential actors in adapted sport participation. However, little is known about their experiences with adapted sport. The current study sought to explore the experiences of families in adapted sport through the context of the Invictus Games, an international adapted sport competition for military personnel with physical and psychologic...

A recent scoping review found that stressors involved in the military lifestyle (i.e., frequent relocation, parental absence, and risk of parental injury) may be associated with mental health issues among military-children. However, most of the included studies were conducted in the United States with little Canadian representation. To examine the...

The impacts of suicidality on families are well known, which is particularly relevant in at-risk populations, such as active duty military personnel and Veteran communities. This scoping review describes how military and Veteran families have been conceptualized within suicide prevention research. A systematic, multi-database search was conducted,...

Public safety personnel (PSP) are known to experience difficult and demanding occupational environments, an environment that has been complicated by the COVID-19 pandemic. Firefighters, paramedics, and public safety communicators were among the front-line workers that continued to serve the public throughout the course of the pandemic. The present...

The military lifestyle can be defined by a triad of unique stressors: frequent relocation, parental absence, and risk of injury, illness and/or death of a serving member. Research has suggested that this unique triad of stressors can impact the mental health of children and youth living in military families. However, research focusing on the mental...

Background: Public safety personnel (PSP; e.g., border services personnel, correctional workers, firefighters, paramedics, police, public safety communicators) are frequently exposed to potentially psychologically traumatic events. Such events contribute to substantial and growing challenges from posttraumatic stress injuries (PTSIs), including bu...

A recent scoping review indicated military-connected children face stressors that may increase mental health issues. However, the majority of the included literature was American. To examine the experiences of Canadian military-connected children, we conducted in-depth interviews with a purposive sample of Canadian military-connected youth using a...

Objective This qualitative study explores the experiences of 26 family members supporting Canadian Armed Forces veterans living with mental health problems including operational stress injuries (OSIs). Background The research focusing on military‐connected families emphasizes the impacts of service on the families. Little is known about how famili...

To date, American research has provided the foundation for what is known about the educational experiences of students living in military families. Given contextual differences that exist between the United States and Canada, it is unclear how representative the American findings are of the Canadian experience. Using semi-structured interviews, thi...

Background Occupational exposures may result in Canadian military Veterans having poorer health and higher use of health services after transitioning to civilian life compared to the general population. However, few studies have documented the physical health and health services use of Veterans in Canada, and thus there is limited evidence to infor...

Research emphasizing the negative psychosocial impacts of service-related post-traumatic stress disorder (PTSD) for military members, veterans, and their families is well established. Post-traumatic growth (PTG), positive psychological change resulting from managing adverse life events and situations, is an alternate outcome considered in research...

Introduction Occupational exposures related to military service may increase the risk of cancer for military Veterans, while high levels of fitness during service may decrease risk. However, few studies have compared this post-career cancer risk directly to the employed general population. Methods This retrospective cohort study used linked admini...

Emergency responders (ERs), often termed First Responders, such as police, fire and paramedic roles are exposed to occupational stressors including high workload, and exposure to trauma from critical incidents, both of which can affect their mental health and wellbeing. Little is known about the impact of the ER occupation on the mental health and...

Moral injury is a relatively new, but increasingly studied, construct in the field of mental health, particularly in relation to current and ex-serving military personnel. Moral injury refers to the enduring psychosocial, spiritual or ethical harms that can result from exposure to high-stakes events that strongly clash with one's moral beliefs. The...

The families of public safety personnel (PSP) face demands that are unique to these occupations. Nonstandard work, trauma exposure, and dangerous work environments affect both workers and the families who support them. This narrative review aims to identify the stressors that PSP families experience and the support and resources needed to enhance f...

Public safety personnel (PSP) are frequently exposed to potentially psychologically traumatic events (PPTEs) which can impact mental health. To help mitigate the negative effects of PPTEs, PSP commonly rely on peer support. Peer support generally refers to a wide variety of mental health resources that offer social or emotional assistance to a peer...

Background: In Canada, more than 64 000 children are growing up with 1 or both parents in the military. We compared mental health service use by children and youth in military families versus the general population, to understand potential mental health service gaps. Methods: This was a matched retrospective cohort study of children and youth (a...

Introduction: Co-occurring PTSD and dementia in Veterans can be difficult to distinguish from dementia-related responsive behaviours, which may result in inappropriate care management. Improved identification of PTSD and dementia is necessary to inform more appropriate and effective care for Veterans. Aim/question: The purpose of this study was...

Background Military-related posttraumatic stress disorder (PTSD) is a complex diagnosis with non-linear trajectories of coping and recovery. Current approaches to the evaluation of PTSD and treatment discontinuation often rely on biomedical models that dichotomize recovery based on symptom thresholds. This approach may not sufficiently capture the...

Co-occurring posttraumatic stress disorder symptoms and dementia can result in increased symptoms, such as suspicion, aggression, and nightmares in Veterans that can be difficult to manage in long-term care environments. The objective of the study was to explore how the co-occurrence of posttraumatic stress disorder symptoms and dementia are unders...

Volunteer and career firefighters are at risk of major depressive disorders, posttraumatic stress disorder (PTSD), alcohol use disorder, and other mental health disorders due to the demanding and unpredictable nature of their employment. The mental health risks are exacerbated by the need to work extended hours, night shifts, and/or rotating schedu...

Introduction Knowledge about the factors that contribute to the correctional officer’s (CO) mental health and well-being, or best practices for improving the mental health and well-being of COs, have been hampered by the dearth of rigorous longitudinal studies. In the current protocol, we share the approach used in the Canadian Correctional Workers...

LAY SUMMARY This study tried to answer the question “Do children and youth in military families have a greater risk of emotional and behavioural problems than children and youth in the general population?” The authors used routinely collected health data from children and youth in Canadian Armed Forces families who relocated to Ontario, matched to...

Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the...

Objective: The objective of this review is to describe the experiences of children growing up in military families whose parents have military-related post-traumatic stress disorder. Introduction: Whether serving as a peacekeeper or warrior, military service is both physically and psychologically demanding, increasing exposures to potentially tr...

Introduction: Military occupations have historically been, and continue to be, male dominated. As such, female military Veteran populations tend to be understudied, and comparisons of the physical health status and patterns of health services use between male and female Veterans are limited outside of US samples. This study aimed to compare the ph...

Background Public safety occupations are well-recognized to be dangerous and stressful. Despite recent attention on post-traumatic stress injuries among public safety personnel, there has been considerably less attention paid to the ongoing ways in which the risks and requirements associated with those occupations shape family life, and how familie...

Introduction The lives of Canada’s military families are characterized by persistent stressors that can play a role in the health and development of children and youth. Military families are cared for by civilian physicians who may not be aware of this unique experience and risk. Our study sought to explore the knowledge and experiences of paediatr...

Introduction The COVID-19 pandemic, including associated public health measures such as travel restrictions, cancellation of elective surgeries, and the closure of public spaces and retail services (full list available at: https://github.com/jajsmith/COVID-19NonPharmaceuticalInterventions ), has resulted in risks to the health and well-being of Vet...

Background. Occupational therapists and teachers often collaborate for the benefit of students. Purpose. This work aims to develop a conceptual framework for collaboration between occupational therapists and teachers in a school-based setting. Methods. A multiple method, qualitative methodology was employed. An integrative analysis of findings betw...

The spouses of military members experience frequent geographic mobility, absences, risk, and other lifestyle dimensions that may cause a greater need for mental health services and barriers to their use, relative to civilians. This was a retrospective, matched cohort study of female spouses of Canadian Armed Forces (CAF) members posted between 04/0...

Exposure to psychological trauma can cause disruptions in employment; however, program-level return to work (RTW) best practices for clients with trauma-related mental health conditions are limited. We completed an environmental scan to identify RTW programs for this population. English-language webpages from Australia, Canada, New Zealand, the UK,...

Background: There are no data on the impact of COVID-19 and associated public health measures, including sheltering at home, travel restrictions, and changes in health care provision, on the mental health of older veterans. This information is necessary for government and philanthropic agencies to tailor mental health supports, services, and resou...

LAY SUMMARY Veterans and their families in the military-to-civilian transition (MCT) face a multitude of changes and challenges. Family members of those Veterans experiencing a significant mental health problem (e.g., posttraumatic stress disorder, depression, anxiety) may find that navigating the MCT is made more complex, especially as they seek t...

Background: Firefighters partake in and are exposed to a range of potentially traumatic events throughout their careers and the impact of such critical events could last a life time. Therefore, capturing such lifetime exposures is necessary for supporting firefighter health. Objective: To estimate the prevalence of critical incidents in firefigh...

Experiencing work-related trauma can negatively impact coping abilities and daily life participation. Occupational therapists (OTs) often provide health services to workers who have experienced trauma, including military members, veterans, and public safety personnel. The Occupational Therapy Trauma Intervention Framework (OTTIF) is a novel clinica...

Introduction: Firefighters are set to respond to a number of dynamic demands within their roles that extend well beyond fire suppression. These tasks (i.e., heavy lifting, awkward postures) and their unpredictable nature are likely contributing factors to musculoskeletal disorders (MSDs). Several individual studies have assessed the prevalence of M...

Background: Trauma and stress-related mental health conditions can impact a person's ability to participate in work and can cause disruptions in employment. Best practice guidelines for occupational therapy return to work interventions with these populations are limited. Objective: To identify and describe occupational therapy return to work int...

Being a member of a Canadian Armed Forces (CAF) family includes frequent geographic relocations, which may affect the use of mental health and addictions (MHA) services. This was a retrospective cohort study to examine intra-provincial variation in MHA services among CAF children, youth, and spouses posted across the province of Ontario using admin...

Due to an unfortunate turn of events this article was published without the below information which as such should be regarded as part of the article by the reader.

Public Safety Personnel (PSP; e.g., correctional workers and officers, firefighters, paramedics, police officers, and public safety communications officials (e.g., call center operators/dispatchers)) are regularly exposed to potentially psychologically traumatic events (PPTEs). PSP also experience other occupational stressors, including organizatio...

Objective: There is an increased incidence of some mental health disorders such as post-traumatic stress disorder (PTSD) in some members of the military and in some public safety personnel (PSP) such as firefighters, police officers, paramedics, and dispatchers. Upon retirement from the armed forces, many individuals go on to second careers as PSP...

There is increasing use of cultural competency models to guide health care interactions with military community members, including families, however, at this time there is no validated model. This study confirms the accuracy of the Military and Veteran Family Cultural Competency Model (MVF-CCM). Using a systems theory-informed qualitative approach,...

Introduction: Military family life is characterized by frequent relocations, regular periods of separation, and living with the persistent risk of injury or death of their military family member. The cumulative effects of these life events impact the health and wellness of military and Veteran families (MVFs) and may be exacerbated by challenges of...

Introduction: Most military families experience mandatory relocation, or posting, several times during their military career. For Canadian military families, who must access provincial or territorial health care systems, maintaining reasonable continuity of care is a persistent issue. Such challenges may be amplified when a child in a military fami...

Military to civilian transition can significantly affect veterans’ lives. This study aimed to increase understanding of how veteran mental health problems impact the family during the transition to civilian life. We used a sequential multiple qualitative design. Twenty-six family members of veterans with mental health problems completed individual...

Objectives To compare the risk of death by suicide in male veterans with age-matched civilians. Design Retrospective cohort study linking provincial administrative databases between 1990 and 2013 with follow-up complete until death or December 31, 2015. Setting Population-based study in Ontario, Canada. Participants Ex-serving Canadian Armed For...

Emerging research has found an association between post‐traumatic stress disorder (PTSD) and dementia in veterans, yet little is known about the nature of this association and how it is conceptualized in the literature. The purpose of this scoping review is to understand how the relationship between PTSD and dementia in veterans is recognized and d...

Background.: People who are diagnosed with posttraumatic stress disorder (PTSD) can experience disruptions in their daily occupations. Occupational therapists may assist clients with PTSD to reengage in meaningful occupations. Purpose.: This scoping review aims to identify and describe the ways occupational therapy addresses PTSD in clinical pra...

Objectives Children growing up in military families are naturally exposed to certain elements of the military family lifestyle, which has been characterized by a unique triad of mobility, family separation, and risk. The extent to which this lifestyle may affect mental health across developmental phases among those children is unclear. The purpose...

This was a retrospective cohort study linking provincial administrative databases to compare rates of non-fatal self-harm between CAF and RCMP veterans living in Ontario and age-matched civilians. This study included male veterans who registered for provincial health insurance between 2002 and 2013. A civilian comparator group was matched 4:1 on ag...

BACKGROUND: Firefighters have high rates of exposures to critical events that contribute to physical and mental stress, resulting in high rates of injury and work-injury compensation claims. OBJECTIVE: To determine the prevalence of critical incidents in firefighters from a single fire service, and whether the number of critical events varied based...

Background Most military families experience mandatory relocation, or posting, several times during the military career. For Canadian military families who must access provincial or territorial health care systems, maintaining reasonable continuity of care is a persistent issue. Such challenges may be amplified when a child in a military family has...

In public safety, individuals working behind what are often traditionally thought of as the frontlines, such as dispatchers, 911 operators, administrators, health professionals, and civilian police officers, as well as non-deployed police and correctional officers, firefighters, and paramedics, provide invaluable and needed support for frontline em...

Public Safety Personnel (PSP; e.g. correctional workers, dispatchers, firefighters, paramedics, police) are frequently exposed to potentially traumatic events (PTEs). Several mental health training program categories (e.g. critical incident stress management (CISM), debriefing, peer support, psychoeducation, mental health first aid, Road to Mental...

Canadian Public Safety Personnel (e.g., correctional workers, dispatchers, firefighters, paramedics, and police) are regularly exposed to potentially traumatic events, some of which are highlighted as critical incidents warranting additional resources. Unfortunately, available Canadian public safety personnel data measuring associations between pot...

Introduction: Canadian military spouses have reported issues accessing and maintaining high quality health care. There is no Canadian research quantifying the scope of the problem. Methods: This is a retrospective cohort study using administrative data. We included military spouses and dependents relocated to Ontario between January 8, 2008 and Mar...

Introduction: Canadian military spouses have reported issues accessing and maintaining high quality health care. There is no Canadian research quantifying the scope of the problem. Methods: This is a retrospective cohort study using administrative data. We included military spouses and dependents relocated to Ontario between January 8, 2008 and Mar...