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.

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