A Quality Improvement Assessment of the Delivery of Mental Health Services among WTC Responders Treated in the Community

Int J Environ Res Public Health. 2019 Apr 30;16(9):1536. doi: 10.3390/ijerph16091536.


The World Trade Center Health Program (WTCHP) provides mental health services through diverse service delivery mechanisms, however there are no current benchmarks to evaluate utilization or quality. This quality improvement (QI) initiative sought to examine the delivery and effectiveness of WTCHP mental health services for World Trade Center (WTC) responders who receive care through the Northwell Health Clinical Center of Excellence (CCE), and to characterize the delivery of evidence-based treatments (EBT) for mental health (MH) difficulties in this population. Methods include an analysis of QI data from the Northwell CCE, and annual WTCHP monitoring data for all responders certified for mental health treatment. Nearly 48.9% of enrolled responders with a WTC-certified diagnosis utilized treatment. The majority of treatment delivered was focused on WTC-related conditions. There was significant disagreement between provider-reported EBT use and independently-evaluated delivery of EBT (95.6% vs. 54.8%, p ≤ 0.001). EBT delivery was associated with a small decrease in Posttraumatic Stress Disorder (PTSD) symptoms over time. Providers engaged in the process of data collection, but there were challenges with adherence to outcome monitoring and goal setting. Data from this report can inform continued QI efforts in the WTCHP, as well as the implementation and evaluation of EBT.

Keywords: disaster mental health; evidence-based treatment; mental health service utilization; quality improvement.

MeSH terms

  • Adult
  • Aged
  • Delivery of Health Care / statistics & numerical data*
  • Emergency Responders / psychology*
  • Emergency Responders / statistics & numerical data
  • Female
  • Humans
  • Male
  • Mental Health Services / statistics & numerical data*
  • Middle Aged
  • New York City / epidemiology
  • Quality Improvement / statistics & numerical data*
  • September 11 Terrorist Attacks / psychology*
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Stress Disorders, Post-Traumatic / psychology