A pilot program to support early intervention and improved outcomes for psychological injury
Overview Background Key elements identified for improvement The pilot program Outcomes How did it go What did we learn Where to form here Questions?
Background • DADHC claims history & what we knew • Identified Key elements needing improvement • meaningfuland 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
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.
RedYellowBlue Black Identifiedimportance 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
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 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 Identifiedimportanceof injury treatment
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
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
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
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.
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
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
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
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