and had difficulty getting to sleep. She awoke over the next few weeks with nightmares, and had difficulty focusing at work. Her chief noticed that she was more withdrawn and in fact was not able to make simple decisions. She was reactive to her colleagues and started to have complaints from colleagues and the public about her curt responses and sudden outbursts.
She was diagnosed with Post Traumatic Stress Disorder and began outpatient treatment with a team including a psychiatrist, psychologist, and an occupational therapist. Following an assessment of Freta’s functional abilities and challenges, she worked with the Occupational Therapist to develop skills in emotional regulation, communication strategies and developed a scheduled routine. Working with the Occupational Therapist to identify weekly exposure goals, a progressive structured program was started. The Occupational Therapist started with Freta in her home to manage her routine, sleep hygiene and self care. She learned ways to manage her anxiety with mindfulness, Cognitive Behavioural Therapy (CBT) and emotional regulation principles. An exposure therapy program was implemented to begin integration into the community and eventually into the workplace.
The Occupational Therapist assessed the job demands of a paramedic and objectively assessed Freta’s functional cognitive and physical abilities through a Functional Assessment. The Occupational Therapist worked with Freta to develop a cognitive rehabilitation program to improve her concentration, her problem solving and her ability to remember important processes for work. Electronic and paper checklists and reminders were built into her daily living and applied into volunteer opportunities in the community.
When Freta demonstrated the physical, cognitive and emotional ability through the community-based programs the Occupational Therapist worked collaboratively with Freta, her manager and her union representative to develop a suitable return to work plan. The plan included a structured reintegration process, some retraining and continued use of the memory tools and checklists in the workplace. At first Freta was apprehensive but as the program progressed she was able to gradually resume some of her key functions which gave her confidence in the tools and her abilities. The Occupational Therapist, using work-focused CBT, assisted Freta in problem solving around workplace challenges with her manager and union. Adjustments to work tools and processes were implemented (physical ergonomic changes such as lifting tools and techniques, communication improvements such as ways to assertively communicate her needs and time management strategies such as using her electronic calendar to remember important tasks). The Occupational Therapist provided the team of paramedics with training on building resiliency skills to prevent PTSD. Through the program, Freta resumed her full work duties.
Note that although Freta’s story ended with her return to work many others may not be able to return to their own role and the Occupational Therapist can assist in exploring a good fit between the employee’s abilities and a new work role to provide success in other jobs that may be a better solution for the individual.