Understanding return to work in MSD claims versus psychological injuries, and for younger workers versus older workers

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1 : Celebrating 25 years of research on preventing work injury and disability Understanding return to work in MSD claims versus psychological injuries, and for younger workers versus older workers Peter Smith Open Plenary September 29, 2015

2 Research Team Malcolm Sim, Monash University Tony LaMontagne, Deakin University Rebbecca Lilley, University of Otago Sheilah Hogg-Johnson, Institute for Work & Health Christina Dimitriadis (Project Coordinator), Monash University 2

3 Research Partners WorkSafe Victoria SafeWork Australia Office of The Age Discrimination Commissioner Beyond Blue Australian Industry Group Other organisations involved Social Research Centre Institute for Safety, Compensation and Recovery Research (ISCRR) 3

4 What I want to do Tell you a little about Victoria and our study Show you lots of descriptive results What I want you to do Tell me what you think is interesting Ask me questions 4

5 Setting the context (1) Traditionally most workers compensation agencies in Canada have restricted mental health related claims to acute reactions to unexpected events Some workers compensation agencies (e.g. BC in 2012) have started to include a broader definition of work related stress disorders In 2014 the Workplace Safety and Insurance Appeal Tribunal allowed an appeal that the Ontario Workplace Safety and Insurance Act s restriction of mental health conditions is an infringement of the Charter of Rights 5

6 Setting the context (2) In Victoria (Australia) workers can lodge a claim for psychological injuries sustained as a result of chronic stress in the course of their employment 6

7 Psychological injuries are associated with greater wage replacement and direct costs following injury Median weeks of wage replacement Psych Claims All Claims $14,000 $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $- Source: SafeWork Australia, 2013 Median direct costs Psych Claims All Claims 7

8 Guidelines on the management of mental health conditions that target occupational health outcomes are relatively rare 8 Joosen et al, OEM, 2015

9 Days of wage replacement following a work injury increase with age: Victoria: 2001 to < Age Group Berecki-Gisolf et al 2012

10 Some other things that make Victoria a little different (1) Employers are responsible for first 10 days of wage replacement, after which injury is reported to the employer s claims agent Management of workers compensation claims is performed by five external WorkSafe Claims Agents. All workplaces with rateable remuneration of $2 million or more are required to have a RTW coordinator at all times. Workplaces with less than $2 million rateable remuneration must appoint a RTW coordinator if an employee is injured 10

11 Some things that make Victoria a little different (2) The obligation for an employer to provide an injured worker with preinjury and/or suitable employment lasts for 52 weeks of incapacity (wage replacement can continue to 130 weeks of incapacity) Workers compensation claimants can sue for damages attributed to injuries that are considered serious under a common-law system 11

12 Our current project Objective to understand the RTW process among workers compensation claimants in Victoria. Focus on the RTW process for: Psychological compared to MSK injuries; and Older workers (55+ years) compared to younger workers. Design: Longitudinal cohort of workers compensation claimants Interviewed ASAP after claim acceptance, then again at 6 and 12 months post-baseline interview Target 960 claimants to achieve a final sample of

13 Injury and recruitment process Injury Event? days Work Incapacity At least 10 work days Claim Submission Up to 7 days Claim contact information sent to SRC Up to 30 days Claim Adjudication/ Acceptance Up to 28 days SRC sends out PAL & study info 21days SRC attempts to contact claimant 13

14 Current Progress Baseline survey: 869 interviews completed for baseline sample Response rate = 53%. 22% psychological claims; 21% 55 years and older. 91% agreed to link data to admin (claim, services, payments) 98% to be re-contacted at 6 months. 6 month follow-up: 468 interviews completed (September 2015) (74% response rate*, 96% when contacted). Modified survey (interview time: less than 30 mins). 12 month follow-up: 138 interviews completed (September 2015) (60% response rate*, 97% when contacted). 14

15 Two ways we will look at age/injury type and return to work/recovery Age or injury type Important predictors of RTW or recovery RTW or recovery outcomes Age or injury type Important predictors of RTW or recovery RTW or recovery outcomes 15

16 Baseline Survey content Intro/consent/eligibility Basic Job Information Workplace reaction to injury Current working status Return to work arrangements RTW Co-ordinator interactions RTW Case Manager interactions Fairness of the RTW process General Health Physical Function and disability Mental Health Self-efficacy to RTW Workplace contact Work Functioning Workplace Characteristics Recovery expectations Health care provider interactions Work Environment and Work Ability pre-injury Employment commitment and meaning of work Demographics Wrap up any issues Interview length < 40 mins 16

17 How does our sample compare to the target population? 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source Population Our Sample 17

18 How does our sample compare to the target population? 30% 25% 20% Source Population Our Sample 15% 10% 5% 0% 18

19 How soon into the RTW process to we get claimants at our baseline interview? 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% LT 2 months 2 to 3 months 3 to 4 months 4 to 5 months Time since injury (SR) (N = 869) Time since injury (Admin) (N = 790) Time since incapacity (N = 790) Time since claim submission (N = 790) 5 to 6 months 6+ months 19

20 Working status at baseline interview (N = 869) 60% 50% 40% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 30% 20% 10% 0% Back at work - same job Back at work - different job Not back - has returned Not back - hasn't returned 20

21 Impact of work injury in the last week at baseline interview (N = 869) 40% 35% 30% Felt disabled Felt angry and frustrated* Felt dependent upon others 25% 20% 15% 10% 5% 0% All the time Most of the time Some of the time A slight bit of the time None of the time 21

22 K6 score above 13 (serious mental illness) at baseline interview (N = 869) 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 22% 45% 32% MSK Psych Less than 35 yrs 25% 24% 35 to 54 yrs 55+ yrs 22

23 The things we think help in the return to work process The health care provider: discusses what worker can and cannot do (even if these things are not related to their job) Gives the worker a date they will return to work The workplace: Makes contact with the worker Has a return to work coordinator who is active in the return to work process Provides an offer of modified/alternate duties; or a return to work plan 23

24 The things we think help/hope that happen in the return to work process The health care provider, the worker and the workplace: Are in contact with each other The claims agent: Treats the worker with respect and provides information to the worker that they need The health care provider, RTW coordinator and the claims agent Are not creating a stressful return to work experience The worker: Believes they can, and that they will, return to work 24

25 The worker 25

26 Most respondents thought they would return to work. 80% 70% 60% 50% 40% 30% 20% 10% * MSK Psych Less than 35 yrs 35 to 54 yrs 55+ yrs 0% Very likely Somewhat likely Not al all likely Respondents not currently at work (N = 357) 26

27 Although they were less sure about returning to their pre-injury duties 60% 50% 40% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 30% 20% 10% 0% Very likely Somewhat likely Not al all likely Respondents not currently at work or on modified duties(n = 643) 27

28 Recovery expectations did not differ by injury type or age group, with most expecting to get better slowly 70% 60% 50% 40% 30% 20% 10% 0% Get better soon Get better slowly Never get better or get worse Already fully recovered All respondents (N = 869) 28

29 Workplace factors 29

30 Psychological and younger claimants were more likely to have a negative supervisor response to their injury 90% 80% 70% 60% 50% 40% 30% 20% 10% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 0% Negative Mixed Neutral Positive Respondents with a supervisor (N = 680) 30

31 Psychological claimants were also more likely to have a negative coworker response to their injury 90% 80% 70% 60% 50% 40% 30% 20% 10% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 0% Negative Mixed Neutral Positive Respondents who worked with co-workers at time of injury (N = 653) 31

32 72% of claimants had been contacted by their workplace, and this did not differ by injury type or age group 80% 70% 60% 50% 40% 30% 20% 10% 0% Workplace has been in contact Workplace has not been in contact All respondents (N = 869) 32

33 Importance of receiving workplace contact during time off work differed by age group, but not by injury type 70% 60% 50% 40% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 30% 20% 10% 0% Very important Important Moderately important Of little importance Unimportant Respondents contacted by workplace (N = 622) 33

34 Claimants with psychological injuries were less likely to have been contacted by their workplace s return to work coordinator 70% 60% 50% 40% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 30% 20% 10% 0% Designated person has been in contact Designated person has not been in contact No designated person All respondents (N = 869) 34

35 Psychological claims and older workers were less likely to have been offered, and accepted modified duties 70% 60% 50% 40% 30% 20% 10% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 0% Offered modified duties and accepted Offered modified duties and Not offered modified duties declined All respondents (N = 869) 35

36 Why did you not accept the offer for modified or alternate duties? 50% 40% 30% 20% 10% MSK Psych 0% Job not changed enough Job offered not meaningful or challenging No modification required Other Respondents who did not accept first offer of modified or alternate duties (N = 132) 36

37 Less than 30% of claimants currently off work had been given a return to work plan. This did not differ by age or injury type 80% 70% 60% 50% 40% 30% 20% 10% 0% Given a return to work plan by employer Not given a return to work plan by employer Respondents that have not returned to work (N = 357) 37

38 The health care provider 38

39 Health care providers often discussed activities that respondent s can do, and activities they should not do 100% 90% 80% 70% 60% 50% * 40% 30% 20% 10% 0% MSK Less than 35 yrs 55+ yrs Discussed possible activities respondent can do Psych 35 to 54 yrs Discussed activities respondent should not do Respondents that have received health care (N = 784) 39

40 Older and psychological claimants were less likely to have been given a return to work date, or a date they would return to pre-injury duties 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs Discussed return to work Given a return to work date Given a date when likely to perform pre-injury duties Respondents that have received health care (N = 784) 40

41 69% of claimants said their HC provider has contacted their employer. The importance of contact differed by injury type but not age group 80% 70% 60% 50% 40% 30% 20% 10% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 0% Very Important Important Moderately Important Of little importance or not important Respondents that have received health care (N = 784) 41

42 The case manager 42

43 86% of claimants reported contact with their case manager (from their claims agent). 38% of those had a change in case manager. No differences were observed by age or injury type 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Contact with case manager Case manager has changed All respondents (N = 869) 43

44 Stress in the return to work process 44

45 Psychological claimants reported more stress in interactions with their health care providers 70% 60% 50% 40% 30% 20% 10% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 0% Not at all stressful Not very stressful A bit stressful Quite a bit/extremely stressful Respondents that have received health care (N = 803) 45

46 Psychological and younger claimants found interactions with RTW coordinator to be stressful 70% 60% 50% 40% 30% 20% 10% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 0% Not at all stressful Not very stressful A bit stressful Quite a bit/ Extremely stressful Respondents that have had contact with their RTW coordinator (N = 607) 46

47 Psychological and younger claimants found interactions with their case manager to be stressful 70% 60% 50% MSK Less than 35 yrs 55+ yrs Psych 35 to 54 yrs 40% 30% 20% 10% 0% Not at all stressful Not very stressful A bit stressful Quite a bit/ Extremely stressful Respondents that have had contact with their case manager (N = 746) 47

48 Has your age influenced your [ ] s decision making about your ability to return to work? 60.0% 50.0% 40.0% HC provider RTW coordinator Claims agent 30.0% 20.0% 10.0% 0.0% 18 to 34 years 35 to 54 years 55+ years 48

49 New findings about the return to work process in Victoria (1) Concerning workers Most workers (69%) believe they will return to work, fewer (44%) think they will return to their pre-injury duties. Workers with psychological injuries are the most apprehensive about returning to work and their previous duties Most workers think their injury will get better slowly 49

50 New findings about the return to work process in Victoria (2) Concerning workplaces Psychological claimants experience more negative reactions from coworkers and supervisors following their injury Most claimants report contact from their workplace, with older workers placing more importance on receiving contact Psychological and older claimants are less likely to have been offered and accepted modified duties Psychological claimants are less likely than MSK claimants to have had contact with their workplace s return to work coordinator Less than 30% of claimants who were currently off work had a return to work plan 50

51 New findings about the return to work process in Victoria (3) Concerning healthcare providers Most claimants are being told what they can do (even if it is not related to their work), and what they should not do Older claimants and those with psychological injuries are not always given a return to work date, or a date they would return to pre-injury duties Older claimants are also less likely than younger claimants to discuss return to work 51

52 New findings about the return to work process in Victoria (4) Concerning stress in the return to work process Psychological claimants were more likely to report stress in their interactions with their health care providers, return to work coordinator and claims agent Younger claimants were more likely to report stress in their interactions with their return to work coordinator and claims agent For psychological and younger claimants, higher stress was partially explained by how they were treated and communication Claimants perceive their age influences decisions in the return to work process, but the impact is greatest among younger workers 52

53 Questions and comments? 53

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