Early Intervention Programs
CAN YOU AFFORD NOT TO?
NT Safe Work Week (26/10/2014 to 1/11/2014)
Rachel Cassar
Current member of NT Workers Compensation Advisory Council
Certificate IV TAE
Graduate Certificate in Rehabilitation Case Management
Masters in Human Services
•
Workplace Rehabilitation
•
Workplace Health & Safety
•
Specialist Consulting
(Early Intervention Programs, In‐house Placement)
•
Specialist Training
So what do we need to do by law?
NT WORKERS REHABILITATION AND COMPENSATION ACT
75A Employer to assist injured worker to find suitable
employment
(1) An employer liable under this Part to compensate an
injured worker shall:
(a) take all reasonable steps to provide the injured
worker with suitable employment; and
(b) so far as is practicable, participate in efforts to
retrain the worker
75B Worker to undertake reasonable treatment & training,
or assessment
Is that the best we can do?
Early intervention means;
Identifying & responding to early
warning signs & reports of injury,
illness, incidents, near misses
Providing assistance to employees
before they:
develop (or in very early stages
of) an injury / illness
take extended absence from
work
possibly lodge a claim for
workers’ compensation.
Early intervention is considered one of
the better practice principles of
occupational rehabilitation.
Why implement E.I. strategies?
“A model of early intervention at the workplace level has been
shown to reduce lost time to one third, halve total claims costs,
and have a major impact on reducing long term off work
claims”.
Dr Mary Wyatt and Dr Clive Sher
……a range of cost effective early intervention identification,
support and treatment initiatives to reduce the number of
employees who are experiencing mental health symptoms from
progressing to full‐blown psychological injuries.
Dr Peter Cotton
Why implement E.I. strategies?
Work Outcomes Research and Cost‐Benefits (WORC) study ‐ 60 Aus public & private
sector organisations, data from > 92,000 employees……
6.7 percent of Australian employees in any organisation suffer from
clinical level depression each year … attendance and job performance
significantly deteriorates.
…substantive R.O.I (in hard $$ terms) achieved by engaging in
proactive health surveillance initiatives & encouraging high risk
individuals to access evidence‐based mental health treatments…
..E.I. strategy reduces the no. of employees who experience mental
health problems from progressing into the workers comp arena (well
established that health outcomes for individuals with the same
clinical profile are worse if they have an accepted workers
compensation claim).
Professor Harvey Whiteford et
Why implement E.I. strategies?
Fundamental principles about the relationship between
health and work
•
Work is generally good for health & wellbeing
•
Long term work absence, work disability, unemployment
negatively impacts health & wellbeing.
•
Work must be safe so far as is reasonably practicable.
•
Work practices & culture, work‐life balance, injury
management programs & work relationships are key
determinates to feeling valued & supported at work,
health, wellbeing & productivity.
•
Health professionals exert a significant influence on work
absence and work disability.
The evidence is compelling:
for most individuals, working improves general health and
wellbeing and reduces psychological distress, and absence from
work is detrimental.
Why implement E.I. strategies?
The Australasian Faculty of Occupational and Environmental
Medicine found in May 2010 that if a person is off work for:
Up to 20 days – the chance of ever getting back to work is 70%.
45 days – the chance of ever getting back to work is 50%.
Why implement E.I. strategies?
5‐10% of claims that take longer than 3 months to recover, account for 75‐90% of
claims costs Indahl, et al. (1995)
Once a worker is off work for 4‐12 weeks, they have a 10‐40% risk of being off
work at 1 year
Worker off work for greater than 1 year it is unlikely they will ever return
regardless of the intervention Carter and Birrell (2000)
FYI
80% RTW rate when referred for occupational rehab prior to 3 month of DOI
50% RTW rate when referred to Occupational Rehab at 3 – 6 months
Let’s look at the costs when an injury
has not been managed early...
So, what does an E.I. program look like?
Many different programs……
•
For non‐work related injuries
•
For injuries not lodged as a claim
(or not accepted)
•
For accepted claims
•
Specific to psychological injury
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Specific to physical injury
•
WHS risk management focused
•
Preventative programs (“Fit for
Work”, health promotions, pre‐
employment assessments etc)
So, what are the general key elements
of E.I. programs?
1. Clear policy / guidelines on supporting employees exhibiting
early warning signs (need not be dependant upon employee
submitting a claim)
2. Manager / Supervisor awareness of the early warning signs and
how to respond (may require training & resources)
3. Early contact with the employee to offer assistance.
Key elements ….
4. Early and expert assessment to identify employee needs.
5. Employee and Supervisor involvement in developing an agreed
plan to enable the employee to remain at work or RTW.
6. Access to effective medical treatment and evidence‐based
therapeutic interventions if there is a psychological condition
(that are RTW focused).
7. Flexible workplace solutions to support the individual at work.
So, what does an E.I. program look like?
EARLY INTERVENTION ACTIONS TO PREVENT PSYCHOLOGICAL INJURY
•
Recognise early warning signs
•
Respond with support and assistance
•
Assess needs and agree on a plan
•
Support recovery and restore work ability
Screening Scoring
OMPSQ score > 85 identifies a person as presenting
with high risk (yellow flags) = referral to an IMC.
Red, orange, blue flags, the therapist is to rates these
factors as:
o
High Risk (factors very likely to impact on RTW)
o
Moderate Risk (factors are either very significant
& well managed or factors are of moderate
significance)
o
Low Risk (factors are unlikely to impact on RTW).
With the rating for risk factors, must be justified in
accordance with other evidence.
The Flags Model:
Red Flags:
Medical
Serious pathology/diagnosis
Co‐morbidity (i.e. co‐existence of other diseases)
Failure of treatment
Yellow Flags:
Psychosocial
Beliefs about pain & injury
Psychological distress (e.g. depression, anger, bereavement)
Unhelpful coping strategies
Perceived inconsistencies and ambiguities in information about the
injury and its implications
Failure to answer patients’ and families’ worries about the nature of the
injury and its implications
Blue Flags:
Social
/Environment
High demand/low control or unsupportive management style
Perceived time pressure
Lack of job satisfaction
Work is physically uncomfortable
Black Flags:
Fact
Employer’s rehabilitation policy deters gradual reintegration or mobility
Threats to financial security
Qualification criteria for compensation
Financial incentives
Lack of contact with the workplace
Duration of sickness absence
Example…. E.I. SOFT TISSUE IJNJURY PROGRAM
Key features:
•
Early screening & triage through modified OMPQ
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Educational video to IW and their manager/supervisor
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Education of NTD and other practitioners
•
Establishing relationship with IW and other stakeholders
•
IMC assessment & discussion with NTD to educate
•
‘Health Coach’ assessment by a registered psychologist and early psych
management of damaging beliefs & attitudes (yellow flags)
•
Case conference with all key stakeholders to review progress and assess
further risk
•
If required, an experienced rehab consultant can work closely with ADHC
IMRC’s
•
Reducing home rest and implementing suitable duties as soon as
medically appropriate
•
Ensuring communication, cooperation and common goals between key
parties
Return to Work Programs in Detail
Key features:
•
Pre injury hours and duties.
•
RTW goal / short term and long term.
•
Table with hours to work, this can include graded
approach.
•
Breaks specified.
•
Duties, be specific however easy to understand.
•
Restrictions be specific as per the medical certificate
provided by the GP.
•
Responsibilities of all parties listed.
•
Review dates listed.
•
Signature of all parties on the program, including GP
if able to.
Example…. E.I. SOFT TISSUE IJNJURY PROGRAM
•
Very important for IW to attend initial visit at the workplace
and ensure they are involved in the rehabilitation and RTW
process
•
Suitable duties must be made available
•
IMRC to manage IW and supervisor/manager relationship
and ensure the supervisor is involved in the RTW process
•
First 2 wks post injury very important, if unable to see IW
within first 2 wks then results will be collated in the ‘late
referrals’ cohort
Points to note and remember
•
Very important for IW to attend initial visit at the workplace
and ensure they are involved in the rehabilitation and RTW
process
•
Suitable duties must be made available
•
IMRC to manage IW and supervisor/manager relationship
and ensure the supervisor is involved in the RTW process
•
First 2 wks post injury very important, if unable to see IW
within first 2 wks then results will be collated in the ‘late
referrals’ cohort
Early Intervention Programs
So, CAN YOU AFFORD NOT
• Whitefoord, H.A., Sheridan. J., Cleary, C.M., & Hilton, M.F. (2005).The work outcomes
research cost‐benefit (WORC) project: the return on investment for facilitating help seeking behaviour.Australian and New Zealand Journal of Psychiatry, 39 (Suppl.2), A37.
• The Australasian Faculty of Occupational & Environmental Medicine and The Royal Australasian College of Physicians introduced the “AUSTRALIAN and NEW ZEALAND CONSENSUS STATEMENT ON THE HEALTH BENEFITS OF WORK POSITION STATEMENT: REALISING THE HEALTH BENEFITS OF WORK • Comcare Early intervention to support psychological health and wellbeing, July 2010. • Linton SJ and Boersma K. Early Identification of Patients at Risk of Developing a Persistent Back Problem: The Predictive Validity of the Orebro Musculoskeletal Pain Questionnaire. Clinical Journal of Pain, 19, 80‐86. • Linton SJ, Nicholas M and MacDonald S. Development of a Short Form of the Orebro Musculoskeletal Pain Screening Questionnaire. Spine, 2011, 36 (22), 1891‐1895.
• Melloh M, Elfering A, Egli‐Presland C, Roeder C, Barz T, Rolli‐Salathe C, Tamcan O, Mueller U
and Theis JC. Identification of Prognostic Factors for Chronicity in Patients with Low Back Pain: A Review of Screening Instruments. International Orthopaedics, 2009, 33, 301‐313.
• Nicholas M, Linton SJ, Watson PJ and Main PJ. Early Identification and Management of
Psychological Risk Factors (“Yellow Flags”) in Patients with Low Back Pain: A Reappraisal.
Physical Therapy, 2011, 91 (5),737‐753.
• Sullivan MJL, Bishop SR and Pivik J. The Pain Catastrophising Scale: Development and
Validation. Psychological Assessment 1995, 7 (4), 524‐532. • Sullivan MJL, Thorn B, Rogers W and Ward CL. Path Model of Psychological Antecedents to Pain Experience: Experimental and Clinical Findings. Clinical Journal of Pain, 2004, 20 (3), 164‐ 173. • Dame Carol Black's Review of the health of Britain's working age population, Working for a Healither tomorrow. 17 March 2008
