A pilot program to support early intervention and improved outcomes for psychological injury

1
A pilot program to support early intervention and
improved outcomes for psychological injury
2
Overview

• Background
• Key elements identified for improvement
• The pilot program
• Outcomes
• How did it go
• What did we learn
• Where to form here
• Questions?

3
Background

• DADHC claims history what we knew
• Identified Key elements needing improvement
• meaningful and timely early actions
• meaningful evidenced based early intervention
• Idea to develop a model that walked the early
  talk
• Inform model for non compensable injury RTW
• Leading Well the NSW Government initiative and
  guidance to agencies in how to better manage
  organistional factors

4

Background
Frequency and Cost - July 2009 Mental Stress
stable at approx 8 of total claims per year.
In general, psychological injury claims cost
nearly twice as much as other claims and the
injured employee is away from work twice as long.
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Red Yellow Blue Black
Identified importance of addressing flags

• Red flags
• serious pathology
• co-morbidity
• failure of treatment
• Yellow flags
• beliefs about pain and injury
• unhelpful coping strategies
• psychological distress
• adopting the sick role
• passive role in recovery

• Blue flags
• low social support at work
• unpleasant work
• low job satisfaction
• excessive demands.
• Black flags
• company policy on rehabilitation
• threats to financial security
• Litigation
• qualification criteria for compensation
• lack of contact with work

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Identified importance of injury treatment

• Characteristics of PASSIVE psychological
  treatments
• Lack of clear and specific goals
• Focus on underlying issues and lack of systematic
  focus on activity involvements
• Lack of any systematic or incremental homework
  prescribed between sessions
• Ongoing regular weekly sessions
• Primary focus on support, encouragement and
  emotional ventilation

• Characteristics of ACTIVE psychological
  treatments
• Collaboratively developed with specific goals
• Focus on specific symptoms and functional
  involvements
• Prescribed regular and incremental practice of
  techniques and strategies between sessions
• Time limited (i.e. agreed end date for review or
  cessation)
• Use of planned breaks and reducing frequency of
  sessions

7
Identified importance of walk the talk partners

• How do we influence our walk the talk partners to
  undertake
• meaningful early actions and interventions?
• Employee
• Nominated treating doctor
• Treating psychologist
• Insurer
• Injury Management Rehabilitation Coordinator
• Local work unit and line manager
• Employee co-workers

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A managed assessment intervention program

• At Provisional Liability Assessment provide
  recommendations for
• Addressing employee and workplace barriers for
  RTW
• Current fitness for work and duties
• Treatment that will assist functional capacity
• Act on recommendations
• 
  Early and meaningful
• At 4 weeks post notification of injury if unfit
  or suitable duties less than 20 hours
• Referral to managed program
• Immediate case conference with walk the talk
  partners
• Develop agreed action plan

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The Program
4 weeks
Assessment Phase
Assessment
Suitability
No
Employer / Insurer to Manage
Yes
Case Conference
Management Phase
Monitor weekly treatment Monitor workplace
intervention Monitor fortnightly reviews with
NTD Progress reports to case manager Case
conference at 6 and 13 weeks Final outcomes report
Program
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How did it go ?

• June 08 to December 08
• 55 claims
• 24 declined
• 31 potentially suitable
• 7 initially referred to the program
• Due to the small number of claims that came
  through in the first 16 weeks of the project,
  regional and date received criteria were expanded
  in October. This resulted in 2 more claims being
  added to the pilot.

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Injury type

• 3 - Being assaulted by a person or persons
• 2 - Exposure to mental stress factors
• 0 - Exposure to workplace or occupational
  violence
• 1 - Harassment
• 2 - Vehicle Accident
• 1 - Work pressure
• 0 - Exposure traumatic event
• Total 9

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Outcomes

• 5 Increase in fitness on medical certificate
• 6 Best practice treatment
• 5 Return to work plans
• 5 Fitness for work obtained
• Qualitative improvement in symptoms and
  functioning
• Professional development to IMRCs
• Injured employees and treating practitioners
  reporting very positive impact of having a
  managed approach with continuity of care

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What we learnt

• Key principals on target but need fine tuning
• 4 weeks too much of a delay
• Organisational factors and resistance to
  mediation
• Treatment provider was not as familiar with
  employer requirements as Rehab Provider
• Delays in getting case conference up and running
• Improved process for measuring and time lost
  against benchmark or comparative group

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Where to from here

• New model underway with provider to combine
• Earlier assessment and actions
• Psychological injury expertise
• Close workplace relationship
• Manage workplace resistance to appropriate
  interventions
• Increased reporting back and monitoring of
  progress
• Improved method to measure and time lost

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Questions