Recovery & Return to Work - Page 2 - First Responders First

Tips for Accommodating a Worker who is Suffering from PTSD

This section is designed to provide you some tips on how to accommodate workers who have PTSD. Research has found that PTSD does have an impact on impaired occupational functioning, particularly as it relates to reduced productivity, presenteeism and absenteeism. This is not an exhaustive list of accommodations, there may be other ideas or options you may wish to use.

Questions to Consider when Accommodating Work

When considering how to accommodate a worker you may what to identify the specific circumstances related to that worker, some questions include:

What is the worker experiencing (signs and symptoms) and what are the limitations?
How will these limitations impact the work that the worker needs to do?
Are there specific job tasks that will be problematic as a result of these limitations?
What accommodations can help address or eliminate these limitations?
Has the worker been asked about possible accommodations, can they help identify specifically how the organization can assist?
In order to facilitate a successful return to work what training should be provided to the leadership team, supervisor or other workers who work with worker?
Is the worker currently receiving care or treatment and if so are they continuing to follow a treatment plan (if this is known)?

Potential Individual Accommodations

There are a range of treatment options for Workers suffering from PTSD. All treatment options should be in line with emerging best practices that are known to be effective and delivered by individuals trained in addressing PTSD including psychologists and psychiatrists. These potential individual accommodations can be used to support workers so that they can stay at work or return to work.

Signs and Symptoms	What this could look like at work	Impact on job tasks	Potential Accommodations
Intrusive Memories	Reduced concentration Difficulty managing time and tasks Increased errors in work Difficulty completing complex tasks Reduced organizational skills	Difficulty completing tasks with deadlines, time pressures or high expectations Inability to complete tasks in which error rate is impacted by reduced concentration Inability to complete complex tasks or multi-task	Reduce distractions in the workplace Sound proofed areas Use of white noise Soothing music Uninterrupted work time Manage completion of work Flexible scheduling Breaking large projects into smaller chunks, with easily achievable goals Provide memory aids such as schedulers, organizers, use of auditory or written cues Weekly meetings with supervisor or mentor to assist with determining goals, reminding of important deadlines, create daily to do lists Restrict tasks with immediate risk for injury if concentration lapses
Avoidance	Social Withdrawal, irritability Relationship problems Difficulty maintaining close relationships Feelings of guilt, depression or worry Social Withdrawal, irritability Relationship problems Difficulty maintaining close relationships Feelings of guilt, depression or worry	Reduced motivation and productivity Increased stress, emotional outbursts Interpersonal difficulties with customers, supervisors and co-workers Decreased ability to deal with conflict or other emotionally charged events Reduced capacity to cope with stressful situations	Encourage use of stress management techniques Allow support animals Allow telephone calls to doctors or others for needed support Use a mentor or supervisor to alert employee if behaviour is becoming unprofessional or inappropriate Encourage the worker to walk away from frustrating situations and confrontations Provide awareness training to supervisors and co-workers Provide partitions or closed doors to allow for privacy Assign supervisor or mentor to be available to answer employees questions Allow for a flexible work environment – scheduling, breaks, leaves for counseling, work from home may not be able to complete tasks with frequent customer contact
Hyper-arousal	Excessive fatigue Exaggerated startle response Hypervigilance Increase in self-medication practices	Reduced concentration, activity and productivity	Allow for flexible start time Provide a place for the employee to sleep during breaks if needed Allow the worker to work one consistent schedule Allow for a flexible work environment Provide goal-oriented workload Identify and remove environmental triggers such as particular smells, or noises Allow a support animal Allow for breaks and provide a place where the worker feels comfortable to use relaxation techniques or contact a support person

Signs and Symptoms

What this could look like at work

Impact on job tasks

Potential Accommodations

Intrusive Memories

Reduced concentration
Difficulty managing time and tasks
Increased errors in work
Difficulty completing complex tasks
Reduced organizational skills

Difficulty completing tasks with deadlines, time pressures or high expectations
Inability to complete tasks in which error rate is impacted by reduced concentration
Inability to complete complex tasks or multi-task

Reduce distractions in the workplace
- Sound proofed areas
- Use of white noise
- Soothing music
- Uninterrupted work time

Manage completion of work
- Flexible scheduling
- Breaking large projects into smaller chunks, with easily achievable goals
- Provide memory aids such as schedulers, organizers, use of auditory or written cues
- Weekly meetings with supervisor or mentor to assist with determining goals, reminding of important deadlines, create daily to do lists

Restrict tasks with immediate risk for injury if concentration lapses

Avoidance

Social Withdrawal, irritability
Relationship problems
Difficulty maintaining close relationships
Feelings of guilt, depression or worry
Social Withdrawal, irritability
Relationship problems
Difficulty maintaining close relationships
Feelings of guilt, depression or worry

Reduced motivation and productivity

Increased stress, emotional outbursts

Interpersonal difficulties with customers, supervisors and co-workers

Decreased ability to deal with conflict or other emotionally charged events

Reduced capacity to cope with stressful situations

Encourage use of stress management techniques
Allow support animals
Allow telephone calls to doctors or others for needed support
Use a mentor or supervisor to alert employee if behaviour is becoming unprofessional or inappropriate
Encourage the worker to walk away from frustrating situations and confrontations
Provide awareness training to supervisors and co-workers
Provide partitions or closed doors to allow for privacy
Assign supervisor or mentor to be available to answer employees questions
Allow for a flexible work environment – scheduling, breaks, leaves for counseling, work from home
may not be able to complete tasks with frequent customer contact

Hyper-arousal

Excessive fatigue
Exaggerated startle response
Hypervigilance
Increase in self-medication practices

Reduced concentration, activity and productivity

Allow for flexible start time
Provide a place for the employee to sleep during breaks if needed
Allow the worker to work one consistent schedule
Allow for a flexible work environment
Provide goal-oriented workload
Identify and remove environmental triggers such as particular smells, or noises
Allow a support animal
Allow for breaks and provide a place where the worker feels comfortable to use relaxation techniques or contact a support person

Supportive Management Techniques

When you are planning how to manage recovery and return to work for your workers, it is important that you are support the managers and supervisors so that they can utilize effective techniques which help keep the worker on track to recovery. Below are a list of tips that may help supervisors and managers implement an individual return to work plan:

Be prepared to provide day to day guidance and feedback, focused on tasks.
Provide written and verbal instructions.
Provide positive praise and reinforcement.
Recognize when the worker is experiencing hyper-arousal symptoms, stress or withdraw and provide support and remind them of mechanisms they can use such as utilizing quiet space, strategies to deal with conflict.
Establish long term and short term goals, breaking down complex tasks.
Provide clear expectations of responsibilities and outline the consequences of not meeting those performance standards.
Plan how to evaluate the effectiveness of the accommodations.

Incorporating Exposure into the Return to Work Process

Triggers in the Workplace

“Trigger” is a stimulus that activates the fight-or-flight response because it reminds one of something traumatic and/or anxiety-provoking. There may be many triggers in the workplace that don’t appear directly related to traumas even if they worked with these things for many years. It is important for the Return to work plans to consider potential triggers and incorporate systematic in-vivo exposures to them. For example – exposure to flashing lights and sirens.

Avoidance of triggers does not give a chance to learn stimuli is usually safe. Exposing ourselves to feared situations will in turn show us that we can handle it. With repeated exposures, severity and duration of anxiety decreases. It is crucial this process happens gradually.

Modified duties can incorporate time & opportunities for controlled exposures such as setting minimum 20 minutes on each shift dedicated to exposure.

Example of Gradual Exposure for a Paramedic employee returning to work

Photos/videos of: ambulance/ truck/car, members in uniform
Stand outside station
Visit inside of station (Rehearse what to say to colleagues/management – assertive communication)
Wear uniform at home
Look at outside, then insides of stationary ambulance/truck/car
Sit in passenger seat
Sit in back (if ambulance)
Work with equipment (e.g., in simulation labs)/run through protocols
Ride as passenger in moving ambulance/truck/car (no sirens/lights)
Ride in back of ambulance/truck/car (no sirens/lights)
Ride as passenger with lights & sirens
Drive (not in service) with driver trainer/peer support member
Ride as third person – observation only
Ride as third person – increasing responsibility (not primary) – days, then nights
Ride as third person – primary responsibility for some calls – days, then nights
Trial two-person teams (day time only)
As progress, trial two-person teams (nights)

Implementing Best Practices in Return to Work

Assessing your Program:

When evaluating your return to work program, some key metrics to monitor are a decrease in both short and long term disability related to PTSD and mental health injury, an increased utilization in the employee assistance program (EAP) and an increase in benefits for psychological support. Indirect metrics may include improved job satisfaction, reduced turnover in important operational roles, reduced stigma related to modified duties, and reduced employee complaints. In addition to outlined return to work practices and modifications, voluntary assessments should be completed to address barriers to recovery and return to work for workers with PTSD.

Family Engagement:

Broader family and community members should also be engaged to support recovery and return to work. This will allow for a quicker return to work and help the first responder move back into their routine. Moreover, engagement with friends and families of workers who are suffering from PTSD increases awareness to PTSD, reduces the stigma, and allows for a community of support. Some examples of how friends and/or family are engaged include:

Open houses, BBQ, family night and other social events, which also provide information about PTSD
Providing family-based peer support that allows family members and caregivers to speak to others who have had similar experiences, in an effort to support themselves and their loved one through recovery.
Offering and funding for time-limited family counselling if required. This can be made available by the employer as part of an insurance benefits package, though an EAP or under circumstances which it is deemed necessary for the well-being and recovery of the worker and their family.

WSIB and Return to Work

The Workplace Safety and Insurance Board provides return to work services for Ontario Workplaces. Information about this process can be found on the WSIB site.

Visit WSIB Site

Learn how to report PTSD to WSIB.