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

More from Risk & Insurance

Black Swan: EMP

Chaos From Above

An electromagnetic pulse event triggered by the detonation of a low-yield nuclear device in Earth’s atmosphere triggers economic and societal chaos.
By: | July 27, 2017 • 9 min read

Scenario

The vessel that seeks to undo America arrives in the teeth of a storm.

The 4,000-ton Indonesian freighter Pandawas Viper sails towards California in December 2017. It is shepherded toward North America by a fierce Pacific winter storm, a so-called “Pineapple Express,” boasting 15-foot waves and winds topping 70 mph.

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Normally, Pandawas Viper carries cargo containers. This time she harbors a much more potent payload.

Unbeknownst to U.S. defense and intelligence officials, the Viper carries a single nuclear weapon, loaded onto a naval surface-to-air missile, or SAM, concealed below deck.

The warhead has an involved history. It was smuggled out of Kyrgyzstan in 1997, eventually finding its way into the hands of Islamic militants in Indonesia that are loosely affiliated with ISIS.

Even for these ambitious and murderous militants, outfitting a freighter with a nuclear device in secrecy and equipping it to sail to North America in the hopes of firing its deadly payload is quite an undertaking.

Close to $2 million in bribes and other considerations are paid out to ensure that the Pandawas Viper sets sail for America unmolested, her cargo a secret held by less than two dozen extremist Islamic soldiers.

The storm is a perfect cover.

Officials along the West Coast busy themselves tracking the storm, doing what they think is the right thing by warning residents about flooding and landslides, and securing ports against storm-related damage.

No one gives a second thought to the freighter flying Indonesian colors making its way toward the Port of Long Beach, as it apparently should be.

It’s only at two in the morning on Sunday, December 22, that an alert Port of San Diego administrator charged with monitoring ocean-going cargo traffic sees something that causes him to do a double take.

GPS tracking information indicates to him that the Pandawas Viper is not heading to Long Beach, as indicated on its digital shipping logs, but is veering toward Baja, Calif.

Were it to keep its present course, it would arrive at Tijuana, Mexico.

The port administrator dutifully notifies the U.S. Coast Guard.

“Indonesian freighter Pandawas Viper off course, possibly storm-related navigational difficulties,” he emails on a secure digital communication channel operated by the port and the Coast Guard.

“Monitor and alert as necessary,” his message, including the ship’s current coordinates, concludes.

In turn, a communications officer in the Coast Guard’s Alameda, Calif. offices dutifully alerts members of the Coast Guard’s Pacific basin security team. She’s done her job but she’s about an hour late.

At 3:15 am Pacific time on December 22, the deck on the Pandawas Viper opens and the naval surface-to-air missile, operated remotely by a militant operative in Jakarta, is let loose.

It’s headed not for Los Angeles or San Diego, but rather Earth’s atmosphere, where it detonates about 50 miles above the surface.

There it interacts with the planet’s atmosphere, ionosphere and magnetic field to produce an electromagnetic pulse, or EMP, which radiates down to Earth, creating additional electric or ground-induced currents.

The operative’s aim is perfect. With a charge of hundreds and in some cases thousands of volts, the GICs cause severe physical damage to all unprotected electronics and transformers. Microchips operate in the range of 1.5 to 5 volts and thus are obliterated by the billions.

As a result, the current created by the blast knocks out 70 percent of the nation’s grid. What began as an overhead flash of light plunges much of the nation into darkness.

The first indication for most people that there is a problem is that their trusty cellphones can do no more than perform calculations, tell them the time or play their favorite tunes.

As minutes turn to hours, however, people realize that they’ve got much bigger concerns on their hands. Critical infrastructure for transportation and communications ceases. Telecommunication breakdowns mean that fire and police services are unreachable.

For the alone, the elderly and the otherwise vulnerable, panic sets in quickly.

Hospital administrators feverishly calculate how long their emergency power supplies can last.

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Supermarkets and other retailers anticipating one of their biggest shopping days of the year on that Monday, December 23, instead wake up to cold homes and chilling prospects.

Grocery stores with their electricity cut off are unable to open and product losses begin to mount. Banks don’t open. Cash machines are inoperable.

In the colder parts of the United States, the race to stay warm is on.  Within a day’s time in some poorer neighborhoods, furniture is broken up and ignited for kindling.

As a result, fires break out, fires that in many cases will not draw a response from firefighting crews due to the communication breakdown.

As days of interruption turn into weeks and months, starvation, rioting and disease take many.

Say good-bye to most of the commercial property/casualty insurance companies that you know. The resulting chaos adds up to more than $1 trillion in economic losses. Property, liability, credit, marine, space and aviation insurers fail in droves.

Assume widespread catastrophic transformer damage, long-term blackouts, lengthy restoration times and chronic shortages. It will take four to 10 years for a full recovery.

The crew which launched the naval surface-to-air missile that resulted in all of this chaos makes a clean getaway. All seven that were aboard the Pandawas Viper make their way to Ensenada, Mexico, about 85 miles south of San Diego via high-speed hovercraft.

Those that bankrolled this deadly trip were Muslim extremists. But this boat crew knows no religion other than gold.

Well-paid by their suppliers, they enjoy several rounds of the finest tequila Ensenada can offer, and a few other diversions, before slipping away to Chile, never to be brought to justice.

Observations

This outcome does not spring from the realm of fiction.

In May, 1999, during the NATO bombing of the former Yugoslavia, high-ranking Russian officials meeting with a U.S. delegation to discuss the Balkans conflict raised the notion of an EMP attack that would paralyze the United States.

That’s according to a report of a commission to assess the threat to the United States from an EMP attack, which was submitted to the U.S. Congress in 2004. But Russia is not alone in this threat or in this capability.

Wes Dupont, vice president and general counsel, Allied World Assurance Company

North Korea also has the capability and the desire, according to experts, and there is speculation that recent rocket launches by that country are dress rehearsals to detonate a nuclear device in our atmosphere and carry out an EMP attack on the United States.

The first defense against such an attack is our missile defense. But some experts believe this country is ill-equipped to defend against this sort of scenario.

“In terms of risk mitigation, if an event like this happens, then that means the best risk mitigation we have has already failed, which would be our military defense systems, because the terrorists have already launched their weapon, and it’s already exploded,” said Wes Dupont, a vice president and general counsel with the Allied World Assurance Company.

The U.S power grid is relatively unprotected against EMP blasts, Dupont said.

And a nuclear blast is the worst that can occur. There isn’t much mitigation that’s been done because many methods are unproven, and it’s expensive, he added.

Lloyd’s and others have studied coronal mass ejections, solar superstorms that would produce a magnetic field that could enter our atmosphere and wipe out our grid.  Scientists believe that an EMP attack would carry a force far greater than any coronal mass ejection that has ever been measured.

An extended blackout, with some facilities taking years to return to full functionality, is a scenario that no society on earth is ready for.

“Traditional scenarios only assume blackouts for a few days and losses seem to be moderate …” wrote executives with Allianz in a 2011 paper outlining risk management options for power blackout risks.

“If an event like this happens, then that means the best risk mitigation we have has already failed … because the terrorists have already launched their weapon, and it’s already exploded.” — Wes Dupont, vice president and general counsel, Allied World Assurance Company

“But if we are considering longer-lasting blackouts, which are most likely from space weather or coordinated cyber or terrorist attacks, the impacts to our society and economy might be significant,” the Allianz executives wrote.

“Critical infrastructure such as communication and transport would be hampered,” the Allianz executives wrote.

“The heating and water supply would stop, and production processes and trading would cease. Emergency services like fire, police or ambulance could not be called due to the breakdown of the telecommunications systems. Hospitals would only be able to work as long as the emergency power supply is supplied with fuel. Financial trading, cash machines and supermarkets in turn would have to close down, which would ultimately cause a catastrophic scenario,” according to Allianz.

It would cost tens of billions to harden utility towers in this country so that they wouldn’t be rendered inoperable by ground-induced currents. That may seem like a lot of money, but it’s really not when we think about the trillion dollars or more in damages that could result from an EMP attack, not to mention the loss of life.

Allianz estimates that when a blackout is underway, financial trading institutions, for example, suffer losses of more than $6 million an hour; telecommunications companies lose about $30,000 per minute, according to the Allianz analysis.

Insurers, of course, would be buffeted should a rogue actor pull off this attack.

Lou Gritzo, vice president and manager of research, FM Global

“Depending on the industries and the locations that are affected, it could really change the marketplace, insurers and reinsurers as well,” said Lou Gritzo, a vice president and manager of research at FM Global.

Gritzo said key practices to defend against this type of event are analyzing supply chains to establish geographically diverse supplier options and having back-up systems for vital operations.

The EMP commission of 2004 argued that the U.S. needs to be vigilant and punish with extreme prejudice rogue entities that are endeavoring to obtain the kind of weapon that could be used in an attack like this.

It also argued that we need to protect our critical infrastructure, carry out research to better understand the effects of such an attack, and create a systematic recovery plan. Understanding the condition of critical infrastructure in the wake of an attack and being able to communicate it will be key, the commission argued.

The commission pointed to a blackout in the Midwest in 2003, in which key system operators did not have an alarm system and had little information on the changing condition of their assets as the blackout unfolded.

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The commission’s point is that we have the resources to defend against this scenario. But we must focus on the gravity of the threat and employ those resources.

Our interconnected society and the steady increase in technology investment only magnify this risk on a weekly basis.

“Our vulnerability is increasing daily as our use of and dependence on electronics continues to grow,” the EMP commission members wrote back in 2004.

But “correction is feasible and well within the nation’s means and resources to accomplish,” the commission study authors wrote. &

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]