WORK: A Journal of Prevention,Assessment & Rehabilitation

This case study is a report of a rehabilitative employment program that used trauma focused group treatment with individuals who suffered from Posttraumatic Stress Disorder (PTSD) post 9/11. The program was developed in order to assist them to return to the work force. These Individuals lost their jobs because of the 9/11 terrorist attack and experienced financial difficulty, yet because of their PTSD symptoms, had difficulty seeking employment. Individuals were selected for group treatment based on the presence of PTSD symptoms as measured by The Posttraumatic Stress Diagnostic Scale, an external locus of control determined by the Internal and External Locus of Control Scale, low self-esteem as per the Self-Efficacy Scale, and hopelessness, as assessed through the Hopelessness Scale. Additional assessments (Role Checklist, Psychiatric Rehabilitation Determination, Vocational Sentence Completion, Activity Record of the Occupational Questionnaire, and an interview that included a work history) were administered by an occupational therapist. Results of these assessments were used to inform group co-leaders (one social worker and one occupational therapist per group) of their members' symptoms, coping mechanisms, attitudes towards work, rehabilitation readiness, life roles and values, and use of time in order to plan appropriate group intervention. Groups met for once-a-week 90 minute sessions. Group leaders used restructuring and systematic prolonged exposure to encourage group members to describe their traumatic experiences in order to neutralize negative affect states, mange symptoms, and work through guilt and distorted perceptions. Members attended until they began gainful employment. Descriptive data revealed that during the first year of the program, 9/11/2001-9/11/2002, 262 of the 3,567 clients seen (13.6%) returned to the work force.

As military conflicts around the world persist, a comprehensive approach in managing behavioral health issues will continue to be a key component of military healthcare. Deployed military personnel frequently exposed to trauma are well-known to be at high risk for developing behavioral health disorders, including combat stress reactions and posttraumatic stress disorder. In the U.S. Army, members of combat operational stress control (COSC) units have unique skills to assist soldiers and their families not only throughout all phases of a deployment, but also throughout a soldier's entire career. The purposes of this article are twofold, first to describe the role of COSC operations with an emphasis on interventions in a deployed environment. The second purpose is to present a case study from Operation Iraqi Freedom highlighting the efficacy of the COSC approach to meet a Soldier's behavioral health needs in a deployed environment.

Objective: This study investigates the depiction of Posttraumatic Stress Disorder (PTSD) in two works of fiction, The Bluest Eye, by Toni Morrison, and Ordinary People, by Judith Guest.

Participants: In each text, the character struggling to mount a defense against the symptoms of PTSD is a child who must confront not only a single, precipitous event but also deleterious, ancillary conditions that threaten to impede the recovery process.

Methods: This is a study in contrast that utilizes a comparative case analysis of two fictional characters.

Results: One child reconstructs an integrated self while the other deteriorates mentally and emotionally.

Conclusions: These results suggest factors such as social supports, economic status, race and aesthetic self-image may play critical roles in a child's resiliency to the symptoms of PTSD.

Resilience and vulnerability refer to an individual's capacity to persevere in the face of adversity. Resiliency and vulnerability are distinctive personal characteristics influenced by environmental factors such as socio-cultural and institutional contexts. Resiliency and vulnerability are not absolute; they are psychosocial constructs of a phenomenological continuum. Hence, a resilient individual is not invincible to all life events but has the capacity to endure in most circumstances. Clients who sustain traumatic injuries or witness traumatic events have a greater vulnerability to stress disorders like posttraumatic stress disorder (PTSD). Occupational therapy practitioners should be cognizant of a client's resilient and adaptive capacities when providing services to a client who has endured a traumatic event. This paper explores resilience theory and its application to occupational therapy practice.

Governmental expectations of placement outcomes were often high given the severity of work barriers that were present in disabled welfare recipients in the United States [11]. The purpose of this article is to identify challenges that were inherent in welfare-to-work programs and solutions to these challenges. Although rich with opportunity, welfare-to-work programs presented the challenge of employing large numbers of difficult-to-employ individuals before their public assistance benefits expired\cite{5}. Many clients also had symptoms of Posttraumatic Stress Disorder (PTSD) secondary to childhood physical or sexual abuse (59%) or severe domestic violence (55%) [8]. Few funds were available for work training and education. Instead, the employment-first model was expected even though most consumers did not have a high school diploma, had not worked in years, and were fearful and resistant about returning to work [3]. Performance based payment systems presented a challenge because the program's future depended on the compliance of its consumers. There was an impetus for substance abusers to return to work even if they were still using drugs, which contradicted the teachings of many recovery models. This paper presents possible solutions to each of these problems and reports outcomes of one particular welfare-to-work program. By examining the challenges of welfare-to-work programs, by identifying solutions, and by realizing that these solutions are inherent in the basic principles of rehabilitation, this article provides therapists with tools and motivation to make unique contributions to this area of practice.

This case study investigated an intervention that enabled an individual with Posttraumatic Stress Disorder (PTSD), Dissociative Identity Disorder (DID), and satanic ritual abuse to return to work after discharge from psychiatric inpatient treatment. The Occupational Questionnaire [88] revealed past difficulties in organization, awareness of time, communication, cooperation, frustration tolerance, competition, stress management, goal setting, and amnesia resulting in incomplete tasks and sporadic attendance at work. The Role Checklist [72] identified alters valuing work and employed in the past. The Modified Interest Checklist [70] identified running as an interest that 24 alters shared. Based on the initial evaluations, three times a week treadmill running was used as an intervention that built work skills (as measured by the Clerical Work Sample of the Valpar Component Work Sample Series [97]) necessary to sustain gainful employment upon discharge. After intervention, this individual improved in awareness of time, stress management, and goal setting abilities and was less amnestic as per the Occupational Questionnaire [88] and four additional alters expressed an interest in work according to the Modified Interest Checklist [70].

The purpose of this article is to provide a brief overview of how Posttraumatic Stress Disorder (PTSD), Depression, and Sensory Processing patterns influence occupational engagement, including work performance. Interventions and outcomes of the Sensory Modulation Program and approaches from Cognitive Behavior Therapy (CBT) are reviewed through single case exploration with a 42 year-old woman in outpatient services. The marked increase in occupational engagement and improved work performance in this single case review demonstrates the need for more research on the use of the Sensory Modulation Program and approaches from CBT with populations with PTSD, Depression, and Sensory Processing disorder.

In this case study, a young women who has chronic verbal, emotional, and physical abuse and was exposed to repetitive adult acts of abuse as a child initially presented with Posttraumatic Stress Disorder (PTSD) marked by constriction and disconnection, which resulted in her feeling passive and tortured. As part of her occupational therapy intervention, based on the occupational adaptation, psychoanalytic, and recovery frames of reference, she was able to use her skills as a musician and lyricist to work through her trauma by performing heavy metal music. She used work to express emotions and tell and retell her story to audiences eager to hear her. Work helped her develop an identity that allowed her to be active in the world and reach out to others through her music. This case study focuses on the intervention – how music and occupation functioned as a foundation for relieving her PTSD.

This author was hired by a defendant's attorney as an expert witness in the evaluation of a plaintiff who filed a lawsuit for the loss of her job and concomitant income due to posttraumatic stress disorder (PTSD) symptoms acquired after sustaining a traumatic injury. This writer evaluated her symptoms, level of function, roles, and interests using a variety of assessments. This case study is a report of the evaluation. The results indicated that the plaintiff developed adequate coping mechanisms to manage her symptoms of PTSD in order to function in her diverse and chosen roles of worker, mother, care giver, wife, family member, volunteer, home maintainer, and religious participant even though she did not return to her prior place of employment. Because of these results, the case was settled out of court in the favor of the defendant.