An important part of developing intervention strategies for PTSD is anticipating possible traumatic exposures and then planning how these things might be addressed in your organization. Here are a few things that you may need to consider:

  • How managers and supervisors should respond to signs and symptoms of PTSD.
  • Early intervention and screening protocols.
  • How to respond to a crisis situation.
  • Knowing how to access treatment and support options
  • What the processes are to report traumatic incident exposures and PTSD diagnosis to WSIB to access workers compensation.
How to Respond to Signs and Symptoms of PTSD in a Worker

It is important for Managers and Supervisors to understand how to appropriately respond to signs and symptoms of PTSD. As part of the workplace Prevention Plan you need to specifically outline the expectations of managers and supervisors when these signs and symptoms present themselves in the workplace. Some tips on how Managers and Supervisors can respond to a worker in distress include:

  • Keep the communication lines open with the worker and ask how you or other team members can provide support, if the worker is not ready to talk wait for them to open up. If they do start to share, do not interrupt, it is often difficult for people with PTSD to ask for help, particular if they feel that they will be stigmatized.
  • Deal with signs and symptoms directly and as soon as possible. If you recognize signs and symptoms it is best to open the dialogue and provide support so that the worker knows they can come and talk to you. It may be difficult for them to open up.
  • Provide information about the options the worker has to address PTSD. Help the worker access support and help resources, if they request or need assistance.
  • Encourage the worker to talk to someone they trust about what has happened, this could be team members identified in the workplace to provide peer support, family members, friends, or a Manager/Supervisor.
  • Share with the worker that what they are experiencing is a normal reaction. Provide information about signs and symptoms and when they should speak to a professional or seek additional help.

Early Intervention and Screening Protocols

While some people may recover from an exposure to a traumatic event, others may develop chronic problems over many years. Your workplace may want to implement regular screening protocols based on the type of work or exposures your workers may be experiencing. First Responders, as part of their job, are exposed to traumatic events. Many individuals in these environments may suffer both short and long term effects as a result of their exposure to the traumatic event.

Screening protocols can help identify workers who are potentially at risk of developing PTSD. For individuals who are exposed to a traumatic event, some evidence suggests that screening should be given at 1 month following the event. Early intervention is important for effective treatment and the severity of the initial traumatic event should be considered when determining the need for early intervention.

Below is a sample screening protocol1 that you may want to consider for your organization:

sample screening protocol

Screening

Health screening is a well-established strategy to promote early detection of illness in at risk groups. Screening for common psychiatric disorders, such as PTSD, can significantly improve rates of diagnosis and reduce time to appropriate treatment, thus overall improving outcomes. Considering the risk for repeated traumatic exposures with First Responders, screening for signs of psychological injury is strongly supported. Those at risk for suicide and other serious mental disorders would also benefit from early and sometimes urgent intervention.

Mental health screening should be offered to all staff in all sectors who may be suffering from a mental health illness including PTSD. Screening should be available for all staff, who have been exposed to traumatic incidents and may be suffering from work-related PTSD.

The following protocol is recommended for employers and occupational health departments:

  • Identify employees that have been exposed to serious incidents, a repeated number of events or who are distressed as a result of any traumatic incident.
  • Once identified, occupational health or other trained staff can deliver by phone or in-person, a screening instrument or protocol.
  • This would serve to identify symptomatic individuals early in the course of and those who develop progressive symptoms of PTSD.
  • Those individuals who screen positive based on a fixed cut-off score would be referred for further assessment and treatment if indicated.
  • Screening should be conducted within 1 month and at 3 and 6 months after serious or repeated exposures.

A positive response to a screen does not necessarily indicate that an employee has Posttraumatic Stress Disorder. However, a positive response does indicate that an employee may have PTSD or trauma-related problems and further investigation of trauma symptoms by a mental-health professional may be warranted.

Specifically for PTSD, several screening methods have been developed. In general, a good screening instrument for PTSD would be brief, sensitive and reliable, consistently identifying those with potential symptoms. Screening tools are not intended to provide a diagnosis, but will help identify those who may require further assessment.

Screening models such as online mental health screening, in-depth mental health screening or routine mental health “check-ups”, or Primary Care (PC-PTSD) screening may be used. The screens do not include a list of potentially traumatic events, which should be tracked, conducted, and maintained by your organization’s Occupational Health and Safety Department.

Occupational Health professionals should be aware of and have access to validated screening tools for PTSD and other mental disorders. They should be trained in how to identify those at increased risk for PTSD, suicide and other mental disorders and refer to appropriate mental health professionals in a timely manner.

The Screening Program should also be re-evaluated annually by Occupational Health professionals and your JHSC to ensure screening is being consistently performed and those screening positive are seeking assessment and treatment.

Important Messaging for Workers about What to Expect

Traumatic events can be very difficult to understand. You can use the following tips to help communicate with all workers, supervisors and managers how to manage their own feelings before, during or after a traumatic event. These tips come from SAMHSA’s (Substance Abuse and Mental Health Services Administration) National Mental Health Information Centre, and are designed to help civilians who volunteer during disaster relief, however the tips are relevant to all traumatic events.2

  • No one who sees a traumatic event is untouched by it.
  • It is normal to feel sadness, grief and anger about what happened and what you saw.
  • It is natural to feel anxious about your safety or the safety of those who are important to you.
  • Acknowledge your feelings, it will help you move forward more quickly.
  • Everyone have different needs and different ways of coping. This is normal.
  • It is healthy to reach out for, and accept help if you need it.

After the Event, Minimizing Stress for the Worker

An important part of managing the crisis is helping your workers minimize their stress when they return to work. You may want to consider the following actions when you are developing your Prevention Plan.

  • Allowing time off for workers who have been involved in the traumatic event.
  • Transitioning workers back into the workplace by initially assigning them to less-demanding jobs.
  • Developing protocols to provide workers with stigma free counselling so that workers can address the emotional aspects of what they have experienced.
  • Instituting debriefing sessions that focus on helping workers put their experiences in perspective and validate what they have seen, done, thought and felt.
  • Providing ongoing education or workshops that provide information on PTSD, stress management and actions workers can take to take care of themselves.
  • Offering group peer support activities.

PTSD Self Assessments

The PTSD Association of Canada has a couple of PTSD checklist that may be useful for your organization, however it is important to note that only a trained mental health professional can provide you with a valid diagnosis of any mental health condition.


Access the Assessments

Self-Assessment: Do I have PTSD? Knowing When to Call a Psychologist or Physician


survey

Below is another assessment option which aligns with the “When to call a Psychologist or Physician” information provided in the Prevention: Just Getting Started section.

Directions: Read each of the statements below. If you have been experiencing these symptoms for more than on month mark the box at the beginning of the statement. When you are done you can print this off and take it to your Psychologist or Physician , or share with your supervisor so that they can help you access the support you need. You should call a Psychologist or Physician if you have been experiencing the symptoms for more than one month and you are experiencing at least:

  • One intrusive memory symptom
  • Three avoidance symptoms and
  • Two hyper-arousal symptoms

Download Assessment
How to Respond to A Crisis Situation

Peer Support: Just Getting Started

Having a peer support program in place is a recognized evidence based practice that is utilized in organizations. It is important to remember that while peer support is an important part of dealing with PTSD, it is not a substitute for professional support. This section talks about some of the basics of peer support and how to get a program started in your workplace, recognizing that when you are starting out with your Prevention Plan and Program you may not have the resources to establish a full peer support team.

Peer support is an intervention that leverages shared experience to foster trust, reduce stigma and create open channels of communication for seeking help, sharing information and support resources. The focus of a peer support program is to establish positive coping strategies, using common language which fosters trust and credibility between team members. Following are some of the benefits of using peer support to address PTSD in the workplace:

  • Peer support is focused on the person. It provides the worker emotional and social support from others who share a common lived experience, the experience may not be specific to the traumatic event, but in relation to the job, emotional pain or mental health challenge that is experienced. It is important for those suffering from PTSD to maintain social relationships.
  • Peer support can help workers cope with memories of the trauma through the process of sharing stories and learning how to deal with emotions such as anger, shame, guilt or fear.
  • Peer support provides a focus on hope and recovery.
  • Peer support can help the worker learn how to talk about what is happening to them and support them in seeking help.
  • Peer support team members bring credibility of lived experience they can speak the same language, they understand the organization and how it operates and they know what services are available to the worker within their organization.
  • Peer support builds trust with other people, which is important when addressing PTSD.

The Mental Health Commission of Canada has established Guidelines for Practice and Training of Peer Support which may be helpful for your organization. If you are Just Getting Started, here are some approaches you may want to consider:

  1. Utilizing the Service Chaplain as a source of Peer Support.
  2. Utilizing a volunteer Peer Support Mentor from the Joint Health and Safety Committee. This person should be provided training to help them fulfill their duties which includes:
    • basic skills to be a peer support mentor,
    • listening skills,
    • psychological first aid, and
    • referral options for workers within the organization.

The benefit of utilizing this approach is that this person is already familiar with your health and safety program and they are a member of team. When selecting this person they should be viewed as being a credible resource, are respected by peers and undergo a selection process.

It is important that the peer supporters are monitored so that they feel supported in their role and can get help they need to deal with trauma related experiences. This could include the provision of access to a behavioural health expert, opportunities to improve peer supporting skills, monitoring of their own health and wellbeing.

Accessing Treatment and Support Options

PTSD Self Assessments

The PTSD Association of Canada has a couple of PTSD checklist that may be useful for your organization, however it is important to note that only a trained mental health professional can provide you with a valid diagnosis of any mental health condition.


Access the Assessments

Understanding the Strengths & Limitations of your Service’s Employee Assistance Program

An important part of developing your prevention plan is understanding the strengths and weaknesses of your service’s Employee Assistance Program (EAP). While many organizations offer this to their workers, the employees of the EAP are not always equipped to deal with the traumatic events that first responders are exposed to and therefore your EAP program may not be the recommended portal for workers who are experiencing PTSD.

It is important that you understand the service strengths and limitations so that you can address any gaps in your prevention plan. You need to find out about the specific provision of service for your workers with regards to PTSD. Remember it is best for workers to receive treatment by a qualified mental health professional who has received training to address PTSD, and under the presumptive legislation diagnosis of PTSD must be made by a Psychologist or Psychiatrist.

Some of the items that you will want to check include:

  • How does the EAP provider screens the calls and if they are equipped to provide service in this area?
  • How many hours of counseling they can receive and if this can be increased for PTSD cases?
  • What qualifications do available counselors have to address PTSD symptoms?
  • What knowledge and experience or training has been provided to the people who are taking employee calls have with regards to the signs and symptoms of PTSD and how is the employee properly referred to a mental health professional with training and experience addressing PTSD?
  • Is the service is available 24/7?
  • What type of assistance is available to help you manage a critical incident?
  • Does the provider provide training for managers on how to spot an employee in crisis and is this included in the package. If it is not included can we pay for it as needed?
  • Does the provider provide peer support training, training for peer support mentors, is this included in the package, or can you pay for this as needed?
  • Does the EAP have other clients in the first responder community,
  • Is there an opportunity to improve the level of service if other members in the first responder were to access the EAP as a single account/client?

One you understand the strengths and limitations of your Employee Assistance Program provider, you will be able to identify the next steps you need to take to provide additional support to your workers. In some cases you may want to contact your colleagues in the first responder community to establish a more robust program.

Communicate the strengths and limitations of your EAP program to your workers so that they are aware of the services and/or processes they will have to go through if they utilize this as a support resource. Remind your workers that is is important that if they think they are experiencing PTSD they should see help from a mental health professional.

Peer support

Understanding other available Support within your Community

There are community supports available to your workers and when you are just getting started in developing your plan these resources can be a very valuable first step. There are a number of distress and crisis centres throughout Ontario and many of these centers offer services which would be beneficial to a worker. Some of the services provide include suicide and crisis intervention, suicide prevention training, community education and suicide survivor support.

You should reach out to your local distress centre and identify the services that they provide. Most of the centers are open 24 hours a day, 7 days a week. Some of the questions you can ask your local distress centre include:

  • Do you provide specific services are provided through your local distress or crisis centre(s)?
  • What are the qualifications of the service providers
  • Are the help line staff equipped to recognize the signs and symptoms of PTSD and then provide appropriate support and direction for the worker?
  • Do they provide training or resources for managers on how to spot an employee in crisis.
  • Do they provide peer support training, training for peer support mentors?

As part of your prevention plan you should communicate the services available through your local distress centre. To find your local distress centre contact information visit: dcontario.org

The Government of Canada also has a Mental Health Helpline. Information about this service can be found on their website: mentalhealthhelpline.ca

Tip: Increasing Benefits Coverage for Psychological Support

Mental illness and PTSD in first responders can have a significant impact on work productivity, working relationships, and cost employers a significant amount in absenteeism, or sick days, and presenteeism, or coming to work when the employee cannot do the work well. Early recognition of mental health concerns, the right resources, and adequate treatment can help people get on the path to recovery and return to work quickly. In addition to supportive resources such as a Peer-Support Team, Employee Assistance Program and Community based mental health services, you should consider increasing health benefits coverage for psychological support in order to more effectively and efficiently prevent onset of mental illness including PTSD and promote a healthier and quicker return to work.

PTSD Treatment Options Available through OHIP

It is important to understand the treatment options which are covered by OHIP, you will need to contact your local healthcare provider to understand the treatment options available to Ontario.

To find a Physician, covered by OHIP, in your area who is trained and has experience addressing PTSD you can search the director of Physicians and Surgeons of Ontario website. cpso.on.ca/public-register/all-doctors

You can search specifically for Psychiatrists in your city on this site.

Note: Psychologists can provide assessment diagnosis and treatment for trauma related disorders as well, however psychologists in private practice are not covered by OHIP and will bill for their services.

The Ministry of Health and Long Term care has entered into preferred provider arrangements with US psychiatric hospitals to provide mental health services related to PTSD. Please note that these services require prior approval from the MOHLTC before it can be covered under OHIP.

The New Orleans Institute: Trauma-Based Disorders

River Oaks Hospital, New Orleans LA

Diagnoses: Post-Traumatic Stress Disorder, Dissociative Identity Disorder, Major Depressive Disorder, etc. with/without Substance Abuse
Gender: F/M
Level of Care: Residential
Typical length of Stay: 30 to 90 days

Partial Hospitalization Program for Post-Traumatic Stress Disorder

Rogers Memorial Hospital, Oconomowoc WI and
West Allis WI

Diagnoses: Post Traumatic Stress Disorder
Gender: F/M
Level of Care: Day Treatment
Typical length of Stay: 30 to 90 days

This information is available on the Ministry of Health and Long Term Care website.

Tip: Benefits of Internal Support

In addition to increased psychological benefits, internal or integrated psychological support and referral should also be considered. Internal support is ideal as it will allow first responders to seek help directly after exposure to a traumatic event, as early intervention is important for the effective treatment and prevention of PTSD. Moreover, internal psychological support will allow employees to take appropriate steps after completing self-screening and self-care assessments, which will ensure symptomatic workers have timely access and referral to mental health treatment. Furthermore, internal support is advantageous as the clinician will have experience with both PTSD and first responders, and a nuanced understanding of the employer in order to help navigate place of employment. This will allow for ease of transition or return to work for employees. As a result, internal psychological support will often lead to increased job commitment, job satisfaction, involvement, positivity, and job performance.

Finding a Psychologists

Psychologists can provide assessment diagnosis and treatment for trauma related disorders as well, however psychologists in private practice are not covered by OHIP. Many extended healthcare benefits offered through organizations to provide coverage for the use of Psychologists. Organizationally, it is considered a best practice to provide additional coverage for treatment of Post Traumatic Stress Disorder or other occupational stress injuries.

The Ontario Psychological Association provides a directory of Psychologists in Ontario. You can search by area of practice, service language, age group, and problem area (Post Traumatic Stress).

Internal Reporting Procedures

As part of your organizational Prevention Plan you will want to establish reporting procedures for PTSD. It is important to consider your existing accident and incident reporting procedures and explore if it can be expanded to include mental health concerns like traumatic mental stress or Post Traumatic Stress Disorder. Following the notification of an injury/illness, Section 51 and 52 of the Occupational Health and Safety Act (OHSA) requires notification to the Ministry of Labour, JHSC or H&S representative and trade union (if applicable) if an employee is critically injured, disabled from performing their own work or receives medical attention resulting from an incident. The details required in these reports, and the parties who must be notified are based on the severity of the injury and are outlined in the OHSA and in Section 5 of the Industrial Establishment Regulation. Of particular importance is the necessity in S 5(2)(j) to include steps to prevent further illness.

Reporting to the WSIB

Reporting a Post Traumatic Stress Disorder through required channels is handled in the same manner as other injuries or illnesses. There are not special requirements set out by the WSIB at this time. When an injury or illness occurs, the employer must submit a Form 7 Report of Injury/Illness within three days.

In many cases, an employee with PTSD will require time off from work, but in some instances, it may be possible to accommodate them with alternate work as they are receiving treatment. The same WSIB form 7 is used regardless of whether the ill/injured employee losses time from work (Lost Time Injury), or only seeks medical attention (No Lost Time Injury). The employee will be sent a Form 6 by the WSIB for completion following the employers submission of the claim.

To report a PTSD injury on your Form 7 you will select “other” and then add PTSD or Post Traumatic Stress Disorder. For a complete explanation of Employer Responsibilities when reporting an accident please visit the WSIB website and review Policy 15-01-02. You’ll receive a confirmation number when you submit online, verifying that your form has been submitted. You can easily review all of the claims you’ve submitted online in the past 90 days. The online version will automatically complete over half of the form for you.

1. National Institute for Health and Care Excellence, 2005.
2. Occupational Health and Safety Administration, 2016