Improving Outcomes

Taking the Psych Out of Psychosocial

A drive to mitigate psychosocial factors exposes questions about defining them.
By: | December 8, 2014 • 5 min read

Could taking the “psych” out of the word “psychosocial” help advance emerging strategies for workers’ compensation claims that stubbornly defy resolution?

But without any doubt, workers’ comp payers are increasingly interested in strategies, and willing to pay for services, that mitigate psychosocial factors known to impede the recovery of injured workers and their timely return to work, experts said.

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Workers’ comp service providers, meanwhile, are increasing product offerings for mitigating psychosocial barriers that stall the recovery of workers with physical injuries. Expect the trend to continue as analytical capabilities improve for predicting which claims will benefit from such attention, said Michael Lacroix, a psychologist and director of behavioral health at Coventry Workers’ Comp Services.

“People think ‘psychosocial,’ because [it starts with] p-s-y-c-h-o, we are talking about psychological challenges, that we are talking mental and nervous conditions.” — Ruth Estrich, chief strategy officer, MedRisk

Although attitudes are shifting, workers’ comp payers have been reluctant to address psychosocial problems and there remains lingering confusion over the word’s definition.

Not all psychosocial factors are mental health problems or require the attention of a psychologist or mental health expert, explained Jennifer Christian M.D., president of Webility.md, a management consulting company specializing in workers’ comp and disability.

Psychosocial factors are much broader. They can include economic circumstances, an injured worker’s health illiteracy, cultural influences, coping skills or resiliency, and workplace situations, she added.

Yet the term psychosocial remains stigmatized by a common belief that it refers exclusively to psychiatric diagnosis, which workers’ comp payers historically spent heavily on without obtaining positive claims results, Christian said.

The experience and the word’s prefix drive a predisposition that hampers broader support for addressing psychosocial risk factors.

“Part of issue is confusion over the term psychosocial,” Christian said. “Some people read ‘psychosocial’ to mean mental health problems. In the workers’ comp industry and payer industry, they have poured resources down black holes of ineffective mental-health services so they don’t want do that anymore.”

A fading, but common myth holds that attempts to ameliorate an injured worker’s psychosocial complications will force workers’ comp payers to “buy” psych claims, agreed Ruth Estrich, chief strategy officer for MedRisk, a provider of physical rehabilitation and other services for the workers’ comp industry.

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“People think ‘psychosocial,’ because [it starts with] p-s-y-c-h-o, we are talking about psychological challenges, that we are talking mental and nervous conditions,” Estrich said.

Psychosocial factors include a person’s lack of knowledge about their injury, Estrich explained. For example, a person with a musculoskeletal injury may fear physical activity due to pain when movement would improve their condition and lack of movement cause further deterioration.

“That actually is a pyschosocial issue,” Estrich said. “It is not a biological issue. It has to do with knowledge and education.”

Overall, there is growing acceptance that psychosocial complications, including mental-health issues, are major factors in claimant recovery and drive costs by preventing speedier claim resolutions, sources said.

Several factors are driving growing interest in addressing psychosocial factors, including Americans’ increased willingness to discuss mental health problems and awareness that current measures for resolving difficult workers’ comp claims have reached their limit and more needs to be done, Lacroix said.

“We have probably reached the point where we spend a great deal of money in workers’ comp and we still have a whole bunch of people who are stubbornly not getting better,” Lacroix said. “When you look at that proportion [of claimants] what you find is what prevents them from getting better is not that physicians are incompetent. It’s not that they are malingering. It’s that there are these other comorbidities and among these other comorbidities are pysch conditions.”

Among other measures for addressing the psych component of claims, Coventry case managers now receive training in cognitive behavior therapy concepts and other techniques that help them identify psychosocial barriers preventing an injured worker’s timely return to the job.

There may be a broader array of factors beyond psychological or mental health issues hampering injured worker recovery, Lacroix added. But factors such as cultural influences on a worker’s recovery are harder to quantify than are psychological impediments, he said.

Meanwhile, treatment guidelines tend to focus on psychological issues rather than on the broader array of factors some experts consider psychosocial barriers to worker recovery. That drives insurers’ willingness to pay for psych treatments over paying for non-psych psychosocial factors impacting a claimant, Lacroix said.

But employers are increasingly interested in addressing a broader range of psychosocial problems as they seek solutions for claims that drag on, Estrich said.

“I think we are reaching the tipping point,” she added.

Estrich points to a breakout session held at the National Workers’ Compensation and Disability Conference & Expo this past November. The session on “Overcoming Psychosocial Barriers to Recovery” drew a standing-room-only crowd.

The presentation included Carrie Freeland, manager of integrated leave at Costco Wholesale. She discussed successes the employer has experienced with a Progressive Goal Attainment Program.

PGAP’s approach pairs injured workers displaying psychosocial risks with experts in fields such as physical or occupational therapy.

It is an evidence-based program, meaning it has been proven to work, Christian said. And it tightly limits the number of sessions an injured worker will spend with a professional.

PGAP is “not psychological” because it does not address an injured worker’s past and it is delivered by a variety of professionals such as physical therapists and vocational consultants, Christian said.

Such measures help PGAP assuage the concerns of payers who may otherwise balk at funding psychological services, Christian added.

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“They are trying to get the stigma of mental health providers off of it so payers will be more willing to pay,” she said.

So, could de-emphasizing the “psych” in psychosocial help advance emerging remedies for workers’ comp claims that stubbornly defy resolution?

Perhaps. But the problem remains that there is a lack of a good prefix to replace ‘psycho’ when defining the array of personal, social, and environmental factors which can influence human behavior, Christian said.

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

More from Risk & Insurance

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Emerging Risks

Stadium Safety

Soft targets, such as sports stadiums, must increase measures to protect lives and their business.
By: | January 10, 2018 • 8 min read

Acts of violence and terror can break out in even the unlikeliest of places.

Look at the 2013 Boston Marathon, where two bombs went off, killing three and injuring dozens of others in a terrorist attack. Or consider the Orlando Pulse nightclub, where 49 people were killed and 58 wounded. Most recently in Las Vegas, a gunman killed 58 and injured hundreds of others.

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The world is not inherently evil, but these evil acts still find a way into places like churches, schools, concerts and stadiums.

“We didn’t see these kinds of attacks 20 years ago,” said Glenn Chavious, managing director, global sports & recreation practice leader, Industria Risk & Insurance Services.

As a society, we have advanced through technology, he said. Technology’s platform has enabled the message of terror to spread further faster.

“But it’s not just with technology. Our cultures, our personal grievances, have brought people out of their comfort zones.”

Chavious said that people still had these grievances 20 years ago but were less likely to act out. Tech has linked people around the globe to other like-minded individuals, allowing for others to join in on messages of terror.

“The progression of terrorist acts over the last 10 years has very much been central to the emergence of ‘lone wolf’ actors. As was the case in both Manchester and Las Vegas, the ‘lone wolf’ dynamic presents an altogether unique set of challenges for law enforcement and event service professionals,” said John

Glenn Chavious, managing director, global sports & recreation practice leader, Industria Risk & Insurance Services

Tomlinson, senior vice president, head of entertainment, Lockton.

As more violent outbreaks take place in public spaces, risk managers learn from and better understand what attackers want. Each new event enables risk managers to see what works and what can be improved upon to better protect people and places.

But the fact remains that the nature and pattern of attacks are changing.

“Many of these actions are devised in complete obscurity and on impulse, and are carried out by individuals with little to no prior visibility, in terms of behavioral patterns or threat recognition, thus making it virtually impossible to maintain any elements of anticipation by security officials,” said Tomlinson.

With vehicles driving into crowds, active shooters and the random nature of attacks, it’s hard to gauge what might come next, said Warren Harper, global sports & events practice leader, Marsh.

Public spaces like sporting arenas are particularly vulnerable because they are considered ‘soft targets.’ They are areas where people gather in large numbers for recreation. They are welcoming to their patrons and visitors, much like a hospital, and the crowds that attend come in droves.

NFL football stadiums, for example, can hold anywhere from 25,000 to 93,000 people at maximum capacity — and that number doesn’t include workers, players or other behind-the-scenes personnel.

“Attacks are a big risk management issue,” said Chavious. “Insurance is the last resort we want to rely upon. We’d rather be preventing it to avoid such events.”

Preparing for Danger

The second half of 2017 proved a trying few months for the insurance industry, facing hurricanes, earthquakes, wildfires and — unfortunately — multiple mass shootings.

The industry was estimated to take a more than $1 billion hit from the Las Vegas massacre in October 2017. A few years back, the Boston Marathon bombings cost businesses around $333 million each day the city was shut down following the attack. Officials were on a manhunt for the suspects in question, and Boston was on lockdown.

“Many of these actions are devised in complete obscurity and on impulse, and are carried out by individuals with little to no prior visibility.” — John Tomlinson, senior vice president, head of entertainment, Lockton

“Fortunately, we have not had a complete stadium go down,” said Harper. But a mass casualty event at a stadium can lead to the death or injury of athletes, spectators and guests; psychological trauma; potential workers’ comp claims from injured employees; lawsuits; significant reputational damage; property damage and prolonged business interruption losses.

The physical damage, said Harper, might be something risk managers can gauge beforehand, but loss of life is immeasurable.

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The best practice then, said Chavious, is awareness and education.

“A lot of preparedness comes from education. [Stadiums] need a risk management plan.”

First and foremost, Chavious said, stadiums need to perform a security risk assessment. Find out where vulnerable spots are, decide where education can be improved upon and develop other safety measures over time.

Areas outside the stadium are soft targets, said Harper. The parking lot, the ticketing and access areas and even the metro transit areas where guests mingle before and after a game are targeted more often than inside.

Last year, for example, a stadium in Manchester was the target of a bomb, which detonated outside the venue as concert-goers left. In 2015, the Stade de France in Paris was the target of suicide bombers and active shooters, who struck the outside of the stadium while a soccer match was held inside.

Security, therefore, needs to be ready to react both inside and outside the vicinity. Reviewing past events and seeing what works has helped risk mangers improve safety strategies.

“A lot of places are getting into table-top exercises” to make sure their people are really trained, added Harper.

In these exercises, employees from various departments come together to brainstorm and work through a hypothetical terrorist situation.

A facilitator will propose the scenario — an active shooter has been spotted right before the game begins, someone has called in a bomb threat, a driver has fled on foot after driving into a crowd — and the stadium’s staff is asked how they should respond.

“People tend to act on assumptions, which may be wrong, but this is a great setting for them to brainstorm and learn,” said Harper.

Technology and Safety

In addition to education, stadiums are ahead of the game, implementing high-tech security cameras and closed-circuit TV monitoring, requiring game-day audiences to use clear/see-through bags when entering the arena, upping employee training on safety protocols and utilizing vapor wake dogs.

Drones are also adding a protective layer.

John Tomlinson, senior vice president, head of entertainment, Lockton

“Drones are helpful in surveying an area and can alert security to any potential threat,” said Chavious.

“Many stadiums have an area between a city’s metro and the stadium itself. If there’s a disturbance there, and you don’t have a camera in that area, you could use the drone instead of moving physical assets.”

Chavious added that “the overhead view will pick up potential crowd concentration, see if there are too many people in one crowd, or drones can fly overhead and be used to assess situations like a vehicle that’s in a place it shouldn’t be.”

But like with all new technology, drones too have their downsides. There’s the expense of owning, maintaining and operating the drone. Weather conditions can affect how and when a drone is used, so it isn’t a reliable source. And what if that drone gets hacked?

“The evolution of venue security protocols most certainly includes the increased usage of unmanned aerial systems (UAS), including drones, as the scope and territorial vastness provided by UAS, from a monitoring perspective, is much more expansive than ground-based apparatus,” said Tomlinson.

“That said,” he continued, “there have been many documented instances in which the intrusion of unauthorized drones at live events have posed major security concerns and have actually heightened the risk of injury to participants and attendees.”

Still, many experts, including Tomlinson, see drones playing a significant role in safety at stadiums moving forward.

“I believe the utilization of drones will continue to be on the forefront of risk mitigation innovation in the live event space, albeit with some very tight operating controls,” he said.

The SAFETY Act

In response to the terrorist attacks on Sept. 11, 2001, U.S. Homeland Security enacted the Support Anti-Terrorism by Fostering Effective

Warren Harper, global sports & events practice leader, Marsh

Technologies Act (SAFETY Act).

The primary purpose of the SAFETY Act was to encourage potential manufacturers or sellers of anti-terrorism technologies to continue to develop and commercialize these technologies (like video monitoring or drones).

There was a worry that the threat of liability in such an event would deter and prevent sellers from pursing these technologies, which are aimed at saving lives. Instead, the SAFETY Act provides incentive by adding a system of risk and litigation management.

“[The SAFETY Act] is geared toward claims arising out of acts of terrorism,” said Harper.

Bottom line: It’s added financial protection. Businesses both large and small can apply for the SAFETY designation — in fact, many NFL teams push for the designation. So far, four have reached SAFETY certification: Lambeau Field, MetLife Stadium, University of Phoenix Stadium and Gillette Stadium.

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To become certified, reviewers with the SAFETY Act assess stadiums for their compliance with the most up-to-date terrorism products. They look at their built-in emergency response plans, cyber security measures, hiring and training of employees, among other criteria.

The process can take over a year, but once certified, stadiums benefit because liability for an event is lessened. One thing to remember, however, is that the added SAFETY Act protection only holds weight when a catastrophic event is classified as an act of terrorism.

“Generally speaking, I think the SAFETY Act has been instrumental in paving the way for an accelerated development of anti-terrorism products and services,” said Tomlinson.

“The benefit of gaining elements of impunity from third-party liability related matters has served as a catalyst for developers to continue to push the envelope, so to speak, in terms of ideas and innovation.”

So while attackers are changing their methods and trying to stay ahead of safety protocols at stadiums, the SAFETY Act, as well as risk managers and stadium owners, keep stadiums investing in newer, more secure safety measures. &

Autumn Heisler is a staff writer at Risk & Insurance. She can be reached at [email protected]