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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Robotics Risk

Rise of the Cobots

Collaborative robots, known as cobots, are rapidly expanding in the workforce due to their versatility. But they bring with them liability concerns.
By: | May 2, 2017 • 5 min read

When the Stanford Shopping Center in Palo Alto hired mobile collaborative robots to bolster security patrols, the goal was to improve costs and safety.

Once the autonomous robotic guards took up their beats — bedecked with alarms, motion sensors, live video streaming and forensics capabilities — no one imagined what would happen next.

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For some reason,  a cobots’ sensors didn’t pick up the movement of a toddler on the sidewalk who was trying to play with the 5-foot-tall, egg-shaped figure.

The 300-pound robot was programmed to stop for shoppers, but it knocked down the child and then ran over his feet while his parents helplessly watched.

Engaged to help, this cobot instead did harm, yet the use of cobots is growing rapidly.

Cobots are the fastest growing segment of the robotics industry, which is projected to hit $135.4 billion in 2019, according to tech research firm IDC.

“Robots are embedding themselves more and more into our lives every day,” said Morgan Kyte, a senior vice president at Marsh.

“Collaborative robots have taken the robotics industry by storm over the past several years,” said Bob Doyle, director of communications at the Robotic Industries Association (RIA).

When traditional robots joined the U.S. workforce in the 1960s, they were often assigned one specific task and put to work safely away from humans in a fenced area.

Today, they are rapidly being deployed in the automotive, plastics, electronics assembly, machine tooling and health care industries due to their ability to function in tandem with human co-workers.

More than 24,000 robots valued at $1.3 billion were ordered from North American companies last year, according to the RIA.

Cobots Rapidly Gain Popularity

Cobots are cheaper, more versatile and lighter, and often have a faster return on investment compared to traditional robots. Some cobots even employ artificial intelligence (AI) so they can adapt to their environment, learn new tasks and improve on their skills.

Bob Doyle, director of communications, Robotic Industry Association

Their software is simple to program, so companies don’t need a computer programmer, called a robotic integrator, to come on site to tweak duties. Most employees can learn how to program them.

While the introduction of cobots into the workplace can bring great productivity gains, it also introduces risk mitigation challenges.

“Where does the problem lie when accidents happen and which insurance covers it?” asked attorney Garry Mathiason, co-chair of the robotics, AI and automation industry group at the law firm Littler Mendelson PC in San Francisco.

“Cobots are still machines and things can go awry in many ways,” Marsh’s Kyte said.

“The robot can fail. A subcomponent can fail. It can draw the wrong conclusions.”

If something goes amiss, exposure may fall to many different parties:  the manufacturer of the cobot, the software developer and/or the purchaser of the cobot, to name a few.

Is it a product defect? Was it an issue in the base code or in the design? Was something done in the cobot’s training? Was it user error?

“Cobots are still machines and things can go awry in many ways.” — Morgan Kyte, senior vice president, Marsh

Is it a workers’ compensation case or a liability issue?

“If you get injured in the workplace, there’s no debate as to liability,” Mathiason said.

But if the employee attributes the injury to a poorly designed or programmed machine and sues the manufacturer of the equipment, that’s not limited by workers’ comp, he added.

Garry Mathiason, co-chair, robotics, AI and automation industry group, Littler Mendelson PC

In the case of a worker killed by a cobot in Grand Rapids, Mich., in 2015, the worker’s spouse filed suit against five of the companies responsible for manufacturing the machine.

“It’s going to be unique each time,” Kyte said.

“The issue that keeps me awake at night is that people are so impressed with what a cobot can do, and so they ask it to do a task that it wasn’t meant to perform,” Mathiason said.

Privacy is another consideration.

If the cobot records what is happening around it, takes pictures of its environment and the people in it, an employee or customer might claim a privacy violation.

A public sign disclosing the cobot’s ability to record video or take pictures may be a simple solution. And yet, it is often overlooked, Mathiason said.

Growing Pains in the Industry

There are going to be growing pains as the industry blossoms in advance of any legal and regulatory systems, Mathiason said.

He suggests companies take several mitigation steps before introducing cobots to the workplace.

First, conduct a safety audit that specifically covers robotics. Make sure to properly investigate the use of the technology and consider all options. Run a pilot program to test it out.

Most importantly, he said, assign someone in the organization to get up to speed on the technology and then continuously follow it for updates and new uses.

The Robotics Industry Association has been working with the government to set up safety standards. One employee can join a cobot member association to receive the latest information on regulations.

“I think there’s a lot of confusion about this technology and people see so many things that could go wrong,” Mathiason said.

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“But if you handle it properly with the safety audit, the robotics audit, and pay attention to what the standards are, it’s going to be the opposite; there will be fewer problems.

“And you might even see in your experience rating that you are going to [get] a better price to the policy,” he added.

Without forethought, coverage may slip through the cracks. General liability, E&O, business interruption, personal injury, cyber and privacy claims can all be involved.

AIG’s Lexington Insurance introduced an insurance product in 2015 to address the gray areas cobots and robots create. The coverage brings together general and products liability, robotics errors and omissions, and risk management services, all three of which are tailored for the robotics industry. Minimum premium is $25,000.

Insurers are using lessons learned from the creation of cyber liability policies and are applying it to robotics coverage, Kyte said.

“The robotics industry has been very safe for the last 30 years,” RIA’s Doyle said. “It really does have a good track record and we want that to continue.” &

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