Mental Health, Wellness, and Resilience for Transit System Workers (2024)

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© 2024 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and the graphical logo are trademarks of the National Academy of Sciences. All rights reserved. ACKNOWLEDGMENTS The research for this document was conducted through one or more programs administered by the Cooperative Research Programs (CRP) of the Transportation Research Board (TRB) of the National Academies of Sciences, Engineering, and Medicine: • Airport Cooperative Research Program (ACRP) research is sponsored by the Federal Aviation Administration (FAA). • Behavioral Traffic Safety Cooperative Research Program (BTSCRP) research is sponsored by the Governors Highway Safety Association (GHSA), and the National Highway Traffic Safety Administration (NHTSA). • National Cooperative Highway Research Program (NCHRP) research is sponsored by the American Association of State Highway and Transportation Officials (AASHTO), in cooperation with the Federal Highway Administration (FHWA). • Transit Cooperative Research Program (TCRP) research is sponsored by the Federal Transit Administration (FTA) in cooperation with the Transit Development Corporation. COPYRIGHT INFORMATION Authors herein are responsible for the authenticity of their materials and for obtaining written permissions from publishers or persons who own the copyright to any previously published or copyrighted material used herein. Cooperative Research Programs (CRP) grants permission to reproduce material in this publication for classroom and not-for-profit purposes. Permission is given with the understanding that none of the material will be used to imply endorsement by TRB and any of its program sponsors of a particular product, method, or practice. It is expected that those reproducing the material in this document for educational and not-for-profit uses will give appropriate acknowledgment of the source of any reprinted or reproduced material. For other uses of the material, request permission from CRP. DISCLAIMER To facilitate more timely dissemination of research findings, this pre-publication document is taken directly from the submission of the research agency. The material has not been edited by TRB. The opinions and conclusions expressed or implied in this document are those of the researchers who performed the research. They are not necessarily those of the Transportation Research Board; the National Academies of Sciences, Engineering, and Medicine; or the program sponsors. The Transportation Research Board does not develop, issue, or publish standards or specifications. The Transportation Research Board manages applied research projects which provide the scientific foundation that may be used by Transportation Research Board sponsors, industry associations, or other organizations as the basis for revised practices, procedures, or specifications. The Transportation Research Board, the National Academies, and the sponsors of the Transit Cooperative Research Program do not endorse products or manufacturers. Trade or manufacturers’ names appear herein solely because they are considered essential to the object of the report. This pre-publication document IS NOT an official publication of the Cooperative Research Programs; the Transportation Research Board; or the National Academies of Sciences, Engineering, and Medicine. Recommended citation: Brennan, S., E. F. Orjuela, K. Hearing, S. Rhoads, L. Zeller, S. G. Farris, A. Lubin, S. S. Bhuyan, L. Derby, and K. Koshy. 2024. Mental Health, Wellness, and Resilience for Transit System Workers. Pre-publication draft of TCRP Research Report 245. Transportation Research Board, Washington, DC.

Research Report and Toolkit ii SUM M A RY CONTENTS SUMMARY ......................................................................................................................................................... 1 SECTION 1: RESEARCH REPORT .................................................................................................................... 5 INTRODUCTION................................................................................................................................................. 6 RESEARCH NEED................................................................................................................................................................. 6 RESEARCH APPROACH ........................................................................................................................................................ 6 CONTENTS OF THIS REPORT............................................................................................................................................... 6 GLOSSARY ............................................................................................................................................................................ 7 CHAPTER 1: PREVIOUS RESEARCH ............................................................................................................... 8 INTRODUCTION .................................................................................................................................................................... 8 THE PERPETUALLY ADVERSE WORK CONDITIONS FOR TRANSIT WORKERS ............................................................... 10 The Adverse Conditions for Bus Operators .............................................................................................................. 10 The Adverse Work Conditions for Train Operators and Other Frontline Workers .................................................. 11 EFFECTS OF THE ADVERSE CONDITIONS ON WORKERS’ HEALTH AND WELL-BEING.................................................. 11 Potential Effects of Adverse Work Conditions on Mental Health............................................................................ 12 Potential Effects of Adverse Work Conditions on Physical Health.......................................................................... 12 Other Potential Effects of Adverse Work Conditions ............................................................................................... 13 WAYS TO ADDRESS THE ADVERSE WORK CONDITIONS ................................................................................................ 13 Improving Workplace Environment .......................................................................................................................... 14 Reducing the Impact of Adverse Environments....................................................................................................... 16 Typical Health and Wellness Promoting Practices by Transit Agencies ................................................................. 17 Barriers to Improving Mental Health and Well-being .............................................................................................. 18 IMPACT OF COVID-19 ON PUBLIC TRANSIT..................................................................................................................... 19 COVID-19 Infection and Mortality among Public Transit Workers .......................................................................... 19 Impact of COVID-19 on the Mental Health of Transit Workers ............................................................................... 20 Impact of COVID-19 on Transit Service and Hiring.................................................................................................. 21 LITERATURE REVIEW CONCLUSION................................................................................................................................. 22 CHAPTER 2: AGENCY INTERVIEWS AND UNION INTERVIEW ................................................................... 24 INTRODUCTION ................................................................................................................................................................. 24 INTERVIEW SELECTION APPROACH................................................................................................................................. 25 Defining Frontline Workers ....................................................................................................................................... 26 CAUSES AND FACTORS THAT IMPACT MENTAL HEALTH ................................................................................................ 26 Well-known and Documented Causes and Factors................................................................................................. 27 Other factors Impacting Mental Health and Wellness ............................................................................................ 28 IMPACT OF COVID-19 PANDEMIC ON MENTAL HEALTH................................................................................................. 29 AGENCY BARRIERS TO RECRUITMENT AND RETENTION ............................................................................................... 30 PRACTICES: CURRENT AND PROPOSED.......................................................................................................................... 31 CONSIDERATIONS FOR DEVELOPING PRACTICES .......................................................................................................... 37 CHALLENGES AND GAPS.................................................................................................................................................. 37 Equal Access.............................................................................................................................................................. 37 EAPs ........................................................................................................................................................................... 37 Expertise .................................................................................................................................................................... 38 Considerations Regarding Unions, Work Rules, and Scheduling ........................................................................... 38

Research Report and Toolkit iii SUM M A RY Leadership and Union Buy-in.................................................................................................................................... 38 Resources and Funding ............................................................................................................................................ 38 FINDINGS AND CONCLUSIONS FROM INTERVIEWS ....................................................................................................... 39 CHAPTER 3: FRONTLINE WORKER EXPERIENCES.................................................................................... 40 INTRODUCTION ................................................................................................................................................................. 40 FRONTLINE WORKER SURVEY FINDINGS ....................................................................................................................... 40 Data Analysis ............................................................................................................................................................. 40 Workplace Conditions and Safety............................................................................................................................. 41 Mental Health Resources.......................................................................................................................................... 43 Solutions .................................................................................................................................................................... 44 FRONTLINE WORKER FOCUS GROUP FINDINGS ............................................................................................................ 47 Causes of Mental Health Stressors for Transit Frontline Workers ......................................................................... 47 Workplace Culture, Personal Safety, Resource Availability, and Other Barriers Related to Frontline Worker Mental Health ............................................................................................................................... 49 Strategies to Improve Frontline Worker Mental Health........................................................................................... 50 KEY TAKEAWAYS FROM FRONTLINE WORKER ENGAGEMENT...................................................................................... 52 CHAPTER 4: FINDINGS AND CONCLUSIONS.............................................................................................. 54 KEY FINDINGS OF THIS RESEARCH................................................................................................................................. 54 Previous Research..................................................................................................................................................... 54 Interviews and Focus Groups ................................................................................................................................... 55 Survey ......................................................................................................................................................................... 56 RECOMMENDED RESPONSES TO WORKER MENTAL HEALTH, WELL-BEING, AND RESILIENCY NEEDS .................... 57 FUTURE RESEARCH .......................................................................................................................................................... 59 SECTION 2: RESOURCES AND TOOLKIT ..................................................................................................... 60 INTRODUCTION.............................................................................................................................................. 61 CASE STUDIES & EFFECTIVE STRATEGIES................................................................................................. 63 INTRODUCTION ................................................................................................................................................................. 63 CASE STUDY #1: USING TECHNOLOGY TO CONNECT EMPLOYEES WITH SUPPORT .................................................... 66 Considerations for Using Technology in Your Wellness Approach.......................................................................... 67 CASE STUDY #2: INCREASED ACCESS TO MENTAL HEALTH SERVICES, TRAINED PROFESSIONALS, AND OTHER BENEFITS .......................................................................................................................................................................... 68 Considerations for Increasing Access to Mental Health Resources....................................................................... 68 CASE STUDY #3: INCENTIVES FOR WELLNESS PROGRAM PARTICIPATION.................................................................. 69 Considerations for Building a Wellness program .................................................................................................... 69 CASE STUDY #4: ON-SITE HEALTH CLINIC SERVICES..................................................................................................... 70 Considerations for On-Site Services ......................................................................................................................... 70 CASE STUDY #5: CREATIVE MARKETING......................................................................................................................... 71 Considerations for Creative Marketing..................................................................................................................... 71 CASE STUDY #6: CRITICAL INCIDENT SUPPORT TEAMS ................................................................................................ 72 Considerations for Starting a Critical Incident Support Team ................................................................................ 72 CASE STUDY #7: RED KITE PROJECT RESILIENCY TRAINING ........................................................................................ 73 Considerations for Implementing Resiliency Training ............................................................................................. 73 CASE STUDY #8: LACTATION VAN FOR NURSING OPERATORS...................................................................................... 74 Considerations for Supporting Parents and Caregivers .......................................................................................... 74 CASE STUDY #9: TRAINING AND MENTORSHIP FOR RETENTION AND ADVANCEMENT .............................................. 75 Considerations for Building a Training and Mentor Program.................................................................................. 75 CASE STUDY #10: OPERATOR RESTROOM WORKGROUP ............................................................................................. 76 Considerations for Building a Similar Program........................................................................................................ 77

Research Report and Toolkit iv SUM M A RY CASE STUDY #11: UNION ASSISTANCE PROGRAM ........................................................................................................ 78 CASE STUDY #12: BEYOND TRADITIONAL EAP SERVICES ............................................................................................. 79 TOOLKIT.......................................................................................................................................................... 81 INTRODUCTION ................................................................................................................................................................. 81 HOW TO USE THIS TOOLKIT ............................................................................................................................................. 81 PROGRAM EVALUATION.................................................................................................................................................... 85 EVALUATING AND IMPROVING EAPS AND UAPS............................................................................................................. 87 ESTABLISHING WELLNESS PROGRAMS.......................................................................................................................... 91 Steps to Establish and Design a Wellness Program................................................................................................ 93 Other Tips and Considerations for Building a Comprehensive Program................................................................ 95 SUPPORT MENTAL HEALTH IN THE WORKPLACE: CHECKLIST FOR LEADERSHIP AND SENIOR MANAGERS............. 96 Be a compassionate leader and establish a supportive tone. ............................................................................... 96 Assess whether you can modify operations, assignments, schedules, policies, or expectations to alleviate or remove stressors. ........................................................................................................ 97 Prepare supervisors to be empathetic and supportive. .......................................................................................... 98 Provide or share information about coping, resiliency, and mental health resources.......................................... 98 HOW TO MAKE THE CASE FOR INCREASED BENEFITS TO SUPPORT MENTAL HEALTH AND WELLNESS ................. 100 Example Messages and Related Statistics ............................................................................................................ 100 Building your own Message .................................................................................................................................... 101 IMPROVING COMMUNICATIONS AND MARKETING OF RESOURCES ........................................................................... 104 Understanding Your Audience ................................................................................................................................ 104 Making the Connection ........................................................................................................................................... 104 Communications and Marketing Worksheet ......................................................................................................... 105 BUILDING TRUST BETWEEN PARTIES............................................................................................................................ 107 Building Trust Tabletop Exercise ............................................................................................................................ 109 INCREASING TRAINING OFFERINGS .............................................................................................................................. 112 Training A: Training for Managers........................................................................................................................... 113 Training B: Leadership and Manager Ride-Alongs................................................................................................. 114 Training C: Intervention Training for Frontline Workers ........................................................................................ 115 Other Considerations for Training Frontline Workers ............................................................................................ 116 PROVIDING SUPPORT DURING AND POST-INCIDENTS................................................................................................. 118 Critical Incident Response Teams .......................................................................................................................... 118 Post-incident Support Best Practices ..................................................................................................................... 120 MODERNIZING OPERATIONAL POLICIES FOR A HEALTHY WORKFORCE..................................................................... 122 Policy Suggestions................................................................................................................................................... 122 Implementation ....................................................................................................................................................... 123 FOSTERING COMMUNITY AMONG FRONTLINE TRANSIT WORKERS ........................................................................... 124 DEVELOPING AND IMPLEMENTING MENTOR AND PEER PROGRAMS ........................................................................ 126 Establish Goals for the Mentorship or Peer Program ............................................................................................ 126 Select a Program Model.......................................................................................................................................... 126 Identify and Appoint Mentors.................................................................................................................................. 127 Measure Success .................................................................................................................................................... 127 SELF-ADVOCACY TOOLS ................................................................................................................................................. 128 Understanding worker rights................................................................................................................................... 128 Dialogue and effective communication with superiors ......................................................................................... 129 Human resources as a partner............................................................................................................................... 129 Peer advocacy and resource groups ...................................................................................................................... 130 BIBLIOGRAPHY ............................................................................................................................................132

Research Report and Toolkit v SUM M A RY APPENDIX .....................................................................................................................................................137 INTERVIEW QUESTION GUIDE ........................................................................................................................................ 137 Welcome & Consent (minute :00 to :05 of interview) ........................................................................................... 137 Section 1: Introductions (minute :05 to :10 of interview) ..................................................................................... 137 Section 2: Introductory Questions & Root Causes (minute :10 to :40 of interview)............................................ 137 Section 4: Current Practice (minute :40 to :55 of interview) ................................................................................ 137 Section 5: Addressing Mental Health and Wellness (minute :55 to :75 of interview)......................................... 138 Section 6: Interview Wrap-up (minute :75 to :85 of interview) ............................................................................. 138 FRONTLINE WORKER FOCUS GROUP QUESTION GUIDE.............................................................................................. 138 Group Member Introductions (minute :10 to :15 of Focus Group)....................................................................... 138 Open-Ended Key Research Question (minute :15 to :60 of Focus Group) .......................................................... 138 SURVEY QUESTIONNAIRE............................................................................................................................................... 140 RESULTS TABLES............................................................................................................................................................ 146

Research Report and Toolkit vi SUM M A RY FIGURES Figure 1: Transit Agencies and States Represented in Interviews ....................................................................................... 26 Figure 2: Workplace Stressors ................................................................................................................................................ 42 Figure 3: How would you prefer that your agency inform frontline workers of the mental health and wellness resources available to you?...................................................................................................................................................................... 45 Figure 4: What types of mental health programs or wellness services would be most helpful if offered in your workplace? ............................................................................................................................................................................... 45 Figure 5: What mental health or wellness training, if any, would be helpful if offered by your agency?............................ 46 Figure 6: Sample Ginger Conversation................................................................................................................................... 66 Figure 7: Entrance to IndyGo's On-Site Health Clinic............................................................................................................. 70 Figure 8: Example “Toilet Talk” Wellness Marketing from IndyGo from 2022 and 2023................................................... 71 Figure 9: TriMet's Lactation Van Interior ................................................................................................................................ 74 Figure 10: Sample Program Evaluation Process using a Capability Maturity Framework................................................... 86 Figure 11: Three Steps to Building Positive Relationships and Increasing Trust .............................................................. 107 Figure 12: Example Set of Shared Goals for Retention....................................................................................................... 108 Figure 13: FTA's Core Values................................................................................................................................................. 124 Figure 14: New York MTA 2022 Bi-Annual Employee Awards Ceremony........................................................................... 124 TABLES Table 1: Implications for Future Research ............................................................................................................................... 4 Table 2: Interviewed Agencies ................................................................................................................................................ 26 Table 3: Implications for Future Research ............................................................................................................................. 59 Table 4: Case Studies.............................................................................................................................................................. 63 Table 5: Toolkit Components .................................................................................................................................................. 81 Table 6: Capability Maturity Matrix Example.......................................................................................................................... 85 Table 7: Worksheet: Improving and EvalUAtion EAPS and UAPs .......................................................................................... 88 Table 8: Components of a Wellness Program........................................................................................................................ 91 Table 9: Worksheet - How to make the Case For Increased Benefits ................................................................................ 102 Table 10: Communicating and Marketing Mental Health Resources Worksheet.............................................................. 105 Table 11: Tabletop Exercise for Building Trust Across Parties............................................................................................ 109 Table 12: Training Solutions for Commonly Faced Challenges........................................................................................... 112 Table 13: Critical Incident Response Team Drill Cards ....................................................................................................... 119 Table 14: Race....................................................................................................................................................................... 146 Table 15: Ethnicity ................................................................................................................................................................. 146 Table 16: Gender ................................................................................................................................................................... 146 Table 17: Educational Attainment ........................................................................................................................................ 146 Table 18: Household Size ..................................................................................................................................................... 147 Table 19: Transit Occupation ................................................................................................................................................ 147 Table 20: Location of Workplace .......................................................................................................................................... 148 Table 21: Are you a member of a workers’ union, or are you represented by a workers’ union? .................................... 148 Table 22: Of those in a union (N=497), do you have access to a Union Assistance Program?........................................ 148 Table 23: Endorsement of Workplace Experiences and Stressor....................................................................................... 149 Table 24: Regression models examining workplace stressors in relation to key mental health outcomes..................... 149 Table 25: Does your agency offer any mental health resources or programs to employees?.......................................... 150 Table 26: Of those with access to resources (n=461), have you ever used the mental health resources or programs available to you at your agency?........................................................................................................................................... 150

Research Report and Toolkit vii SUM M A RY Table 27: Of those with no/unsure access to resources (n=312), would you consider using mental health resources or programs if they were available at your agency?................................................................................................................. 150 Table 28: Reasons for not using services from employer ................................................................................................... 150 Table 29: Format: How would you prefer to participate in mental health support or wellness services?........................ 151 Table 30: Mode: Which of the following ways would you prefer to access mental health support or wellness services? ................................................................................................................................................................................................ 151 Table 31: Timing: Would you prefer mental health resources that were available to you… ............................................. 151 Table 32: How would you prefer that your agency inform frontline workers of the mental health and wellness resources available to you?.................................................................................................................................................................... 151 Table 33: What types of mental health programs or wellness services would be most helpful if offered in your workplace? ............................................................................................................................................................................. 152 Table 34: What mental health or wellness training, if any, would be helpful if offered by your agency?......................... 152 Table 35: What policies would support your mental health and well-being? ..................................................................... 152