APPENDIX

Research Questions and Results

Interview Question Guide

Welcome & Consent (Minute 0:00 to 0:05 of Interview)

Section 1: Introductions (Minute 0:05 to 0:10 of Interview)

Participants introduce themselves, stating their name, role, and department.

Section 2: Introductory Questions and Root Causes (Minute 0:10 to 0:40 of Interview)

1. At your agency, who or what occupations do you consider a “frontline transit worker”? Could you describe the typical frontline worker in terms of age, education, and background?
2. What do you think contributes to or causes mental health problems among frontline transit
3. Please note if challenges vary based on the type of frontline worker.
   1. There are many factors that are well-documented, and these include the list below:
      1. Assaults and confrontations.
      2. Post-traumatic stress disorder from passenger events such as person under train (PUT) and suicide.
      3. Split shifts and inconsistent work schedules contributing to poor nutrition and lack of sleep.
      4. Extended periods of sitting/inactivity.
      5. Lack of time for exercise.
      6. Lack of bathroom access.
   2. Other internal factors/stressors (those factors or stressors which are controlled by work environment).
   3. Other external factors/stressors (those factors or stressors which are outside of the work environment).
4. What are the biggest barriers your agency faces when it comes to recruitment and retention of frontline transit workers?
5. How has the COVID-19 pandemic affected mental health and overall well-being of frontline transit workers? What adverse conditions have been specific to the pandemic?

Section 3: Current Practice (Minute 0:40 to 0:55 of Interview)

1. Does your agency offer any specific mental health services programs to frontline workers?
2. What systems are in place to engage workers and unions in health-related decision-making (e.g., worker surveys, wellness committees, labor-management committees, mental health training, critical incident response training, etc.)?

Open-Ended Key Research Questions
(Minute 0:15 to 0:60 of Focus Group)

This section aims to discover and expand upon the key issues of focus, including identifying a) causes of mental health problems, b) available mental health resources and barriers to use, and c) areas for change/solutions.

Defining the problems: The intent of these questions is to understand the nature and causes of mental health problems and the culture of mental health in transit system agencies.

1. Nature of problems: What are types of mental health problems that transit workers face? a. Do mental health problems differ based on job type?
2. Causes of mental health problems: What do you think contributes to or causes mental health problems among transit workers?
   1. What aspects of your job impact your mental health?
      1. Person Under Train (PUT) incidents/assaults—when, why, preventability.
      2. Bathroom access.
      3. Work schedule.
      4. How is your life outside of work affected?
   2. How has COVID-19 affected mental health and well-being of transit system workers?
   3. Protective factors: What protects someone from mental health problems?
   4. Impact: How does mental health influence your ability to do your job on a day-to-day basis?
      1. Psych: Do you ever have feelings of hypervigilance, anxiety, fear, low morale, anger, hostility?
      2. Work: absenteeism, decreased productivity, limited promotions, liability.

Mitigating the problems: The intent of this section is to understand the existing resources, their use, and barriers to mental health among transit system workers.

1. Culture: What types of conversations do you have around mental health in your workplace?
   1. Messaging: What kind of messages have you gotten from your supervisor or agency about mental health?
   2. Stigma: What sort of concerns do you or your coworkers have around talking about or disclosing mental health problems?
   3. Reporting: How do workplace issues and/or mental health concerns or complaints get handled at your agency?
      1. Who do you report those issues to? (direct manager, HR, union rep, unknown)
      2. What happens after reporting?
2. Resources:
   1. What sorts of mental health resources or programs are you aware of that are available to you at your agency?
      1. Type: Screening, prevention, treatment, in house, external?
      2. Source: How did you learn about the mental health resources that were available to you?
      3. COVID-19: What mental health resources have been established in response to COVID-19, if any?
   2. What has your experience been with these programs, or what have you learned from others who have used these programs?
3. Barriers: What are the barriers to accessing or using mental health resources or services?
   1. Psych: Privacy, stigma, fatigue, overwhelmed, lack of awareness about process/procedures.
   2. System: Low managerial support, paperwork/logistics, organization practices.

Solutions: The intent of this section is to elicit workers’ ideas on how to change systems or create new/revised programs to improve the mental health and well-being of workers.

The final topic we want to discuss with you today is your ideas on the types of supports and resources that would be helpful in supporting the mental health of frontline workers. Please know we will review and consider the suggestions you share to help us frame the guide that will be produced at the end of this study. We cannot guarantee, however, that your agency will implement these ideas. (But we can hope!)

1. What ideas do you have about how to improve the mental health experience of frontline workers?
   1. Resources: What resources are needed to make changes?
2. What changes would you like to see in your agency to better support your mental health and the mental health of your fellow workers?
   1. Resources: What resources are needed to make changes?
3. What sorts of mental health programs would you like to have in your agency?
   1. Resources: What resources are needed to make changes, e.g., Employee Assistance Programs (EAPs) or Union Assistance Programs (UAPs)?

Conclusions: Thinking back on everything we talked about today related to mental health in your workplace, is there anything we didn’t discuss that you feel is important to share with the group?

Thank you all so much for your time and insights today. We really appreciate you sharing your experiences and thoughts with us. Jot down any final suggestions/recommendations on how your workplace can improve mental health.

Survey Questionnaire

Survey Consent

Your employer and union have been invited to participate in a research study being conducted by Rutgers University and Foursquare ITP. The research team is seeking to learn more about your work environment as it relates to your mental health and well-being. This survey should take you approximately 10-15 minutes to complete.

This research is confidential. Your employer will not be notified if you complete the survey. Your participation in the survey is completely voluntary. You may skip any questions you are not comfortable answering. If at any time you wish to stop participating, you are free to do so with no penalty to you.

Up to 6,000 persons may complete this survey. If a report of this study is published, or the results are presented at a professional conference, only group results will be stated. No individual responses will be stated. Any information that could identify you will be kept for the shortest time possible on a secure server and available only to the research team and the Institutional Review Board at Rutgers University. After information that could identify you has been removed, de-identified responses may be used by or distributed to investigators for other research without obtaining additional informed consent from you.

Breach of confidentiality is a risk, but a data security plan is in place to minimize such a risk, with all survey responses to be stored on a password-protected server location maintained by Rutgers University. There are no direct benefits to participation, however, the information you share in completing the survey will help the research team develop strategies to support the mental health and well-being of transit agency frontline workers nationwide.

If you have any questions at any time about the research or procedures, or if you need assistance in completing the survey, you may contact the study principal investigator.

YES, I consent to take the survey

NO, I do not consent to take the survey

1. Do you interact directly with the public as part of your job?
   • Yes
   • No → END SURVEY
2. How many years have you worked in the transit industry?
   • _____ (# of years)
3. Which position best describes your job at your agency?
   • Bus operator
   • Rail operator
   • On-demand or paratransit operator
   • Other type of operator
   • Supervisor of operators
   • Station attendant
   • Field maintenance worker or cleaning crew
   • Dispatcher or control center worker
   • Mechanic
   • Transit police
   • Customer Service Representative or Call Center Worker
   • Office worker, planner, scheduler, or administer (no interaction with the public) END SURVEY
   • Other (please specify)
4. Are you a member of a workers’ union, or are you represented by a workers’ union?
   • Yes
   • No
   • Unsure

4a. [IF YES TO #4] Do you have access to a Union Assistance Program (UAP)?

1. • Yes
   • No
   • Unsure

WORKPLACE CONDITIONS/SAFETY

5. On a 0-10 scale, what level of stress do you typically feel in your work environment?
   • 0 (not at all) - 10 (extremely)
6. Is your agency currently understaffed?
   • Yes
   • No
7. Tell us which the following you have experienced while at work (select all that apply):

MENTAL HEALTH

8. Over the last two weeks, how often have you been bothered by the following problems?

10. How satisfied are you with the current mental health resources available to you at your agency? 0 (not at all) - 10 (extremely)

BARRIERS TO SERVICE USE

SOLUTIONS

These final few questions ask for your input on how we can improve the mental health and well-being of transit workers.

12. How would you prefer to participate in mental health support or wellness services? (select all that apply)
    • Independently/self-guided
    • One on one with a mental health professional
    • One on one with a trained peer
    • Small group with a mental health professional
    • Small group with a trained peer
    • No preference
13. Would you prefer mental health resources that were available to you … (select all that apply)
    • During work hours
    • Outside of work hours
    • No preference

We want to learn more from you! The research team will be convening a brief online focus group discussion with frontline transit workers nationwide in the coming months to learn more about strategies to improve your work environment. Are you interested in potentially participating?

• YES
• NO → END SURVEY

Please provide your contact information so we can follow up with you. Your name will not be linked to the survey responses you just provided.

First name: ___________

Phone or email address: ________________

Results Tables

Table A.1. Race.

Table A.2. Ethnicity.

Table A.3. Gender.

Table A.4. Educational attainment.

Table A.5. Household size.

Table A.6. Transit occupation.

Table A.7. Location of workplace.

Table A.8. Are you a member of a workers’ union, or are you represented by a workers’ union?

Table A.9. Of those in a union (N = 497), do you have access to a union assistance program?

Table A.10. Endorsement of workplace experiences and stressors.

^a N = 774 (total sample responses)

^b N = 542 (operators only); N=3–8 (0.4%–1.3%) missing data

Table A.12. Does your agency offer any mental health resources or programs to employees?

Table A.13. Of those with access to resources (N = 461), have you ever used the mental health resources or programs available to you at your agency?

Table A.14. 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?

Table A.15. Reasons for not using services from employer.

Note: N = 738 (total responses); N = 39 (5.0%) missing data.

Table A.16. Format: How would you prefer to participate in mental health support or wellness services?

Note: N = 736 (total responses); N = 41 (5.3%) missing data.

Table A.17. Mode: Which of the following ways would you prefer to access mental health support or wellness services?

Note: N = 730 (total responses); N = 47 (6.0%) missing data.

Table A.18. Timing: Would you prefer mental health resources that were available to you. . .

Note: N = 729 (total responses); N = 48 (6.2%) missing data.

Table A.19. How would you prefer that your agency inform frontline workers of the mental health and wellness resources available to you?

Note: N = 695 (total responses); N = 82 (10.6%) missing data.

Table A.20. What types of mental health programs or wellness services would be most helpful if offered in your workplace?

Note: N = 712 (total responses); N = 65 (8.4%) missing data.

Table A.21. What mental health or wellness training, if any, would be helpful if offered by your agency?

Note: N = 707 (total responses); N = 70 (9.0%) missing data.

^* Many respondents noted that compassion and empathy training should ideally be targeted to everyone in the workforce, not just managers, to ensure that the whole system is trained in communicating with respect and compassion.

Table A.22. What policies would support your mental health and well-being?

^a N = 694 (total sample responses); N = 83 (10.7%) missing data

^b N = 549 (operators only); N = 57 (10.6%) missing data