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%. 70 days the chance of ever getting back to work is 35%.
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
Why else..?
Let s look at the costs when an injury has not been managed early... http://www.deir.qld.gov.au/workplace/resources/pdfs/ind cost calc.pdf
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 Specific to physical injury WHS risk management focused Preventative programs ( Fit for Work, health promotions, preemployment 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
Example. EARLY PHONE SCREENING
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 Yellow Flags: Psychosocial Blue Flags: Social /Environment Black Flags: Fact Serious pathology/diagnosis Co morbidity (i.e. co existence of other diseases) Failure of treatment 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 High demand/low control or unsupportive management style Perceived time pressure Lack of job satisfaction Work is physically uncomfortable 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 Educational video to IW and their manager/supervisor 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 TO?
Questions?
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