Translating research into action: An evaluation of the World Trade Center Health Registry's Treatment Referral Program

Abstract

This manuscript describes the design, implementation and evaluation of the World Trade Center (WTC) Health Registry's Treatment Referral Program (TRP), created to respond to enrollees' self-reported 9/11-related physical and mental health needs and promote the use of WTC-specific health care. In 2009-2011, the TRP conducted personalized outreach, including an individualized educational mailing and telephone follow-up to 7,518 selected enrollees who resided in New York City, did not participate in rescue/recovery work, and reported symptoms of 9/11-related physical conditions or posttraumatic stress disorder (PTSD) on their most recently completed Registry survey. TRP staff spoke with enrollees to address barriers to care and schedule appointments at the WTC Environmental Health Center for those eligible. We assessed three nested outcomes: TRP participation (e.g., contact with TRP staff), scheduling appointments, and keeping scheduled appointments. A total of 1,232 (16.4%) eligible enrollees participated in the TRP; 32% of them scheduled a first-time appointment. We reached 84% of participants who scheduled appointments; 79.4% reported having kept the appointment. Scheduling an appointment, but not keeping it, was associated with self-reported unmet health care need, PTSD, and poor functioning (≥14 days of poor physical or mental health in the past 30 days) ( < 0.05). Neither scheduling nor keeping an appointment was associated with demographic characteristics. Successful outreach to disaster-exposed populations may require a sustained effort that employs a variety of methods in order to encourage and facilitate use of post-disaster services. Findings from this evaluation can inform outreach to the population exposed to 9/11 being conducted by other organizations.

Association Between Posttraumatic Stress Disorder and Mortality Among Responders and Civilians Following the September 11, 2001, Disaster

“…Despite differences in demographic characteristics, 18 prevalence of comorbidities, 53 and access to monitoring programs 54 between responders and civilians, a similar mortality risk attributed to PTSD was observed. Although previous literature has demonstrated an association between PTSD and morbidity among civilians, 5,55,56 to our knowledge, the present study is among the first to demonstrate increased mortality risk among civilians with PTSD.…”

Impact of healthcare services on thyroid cancer incidence among World Trade Center‐exposed rescue and recovery workers

“…Related to this point is that we did not have CT scan data for non‐MMTP‐rescue/recovery workers. In addition, non‐MMTP rescue/recovery workers may have not enrolled in a New York‐based WTC MMTP for various reasons, including enrollment in the non‐FDNY/GRC federal WTC Nationwide Provider Network, 49 barriers related to the enrollment process, despite sustained efforts to inform them about the program, and not meeting eligibility requirements needed to enroll in a WTC MMTP 50–52 . As such, lack of data related to why they are not enrolled in a New York‐based WTC MMTP, and chest CT data in non‐MMTP rescue/recovery workers may have affected the observed findings.…”

Trajectories of PTSD Among Lower Manhattan Residents and Area Workers Following the 2001 World Trade Center Disaster, 2003–2012

“…Although treatment, but not monitoring, services for certifiable 9/11‐related conditions became available after 9/11 for area residents/workers at a federally funded health program (WTC Health Program for Survivors), previous Registry studies have shown that many individuals eligible for this program had not utilized services prior to a Registry intervention, largely because they were unaware of their eligibility for this program or were not referred to the program by their primary care provider (Welch et al., , ). This emphasizes the need to train community‐based medical providers to recognize symptoms of and risk factors for PTSD and increase their knowledge and awareness of available postdisaster resources to promote timely referrals for those with current, new‐onset, or worsening PTSD symptoms.…”