A workplace accident can leave a worker with a spinal cord injury, an amputation, severe burns or a brain injury, turning their world upside-down. The physical toll is obvious if a worker is missing a limb or immobile. But the psychological hurdles often are hidden.

Recovery can be fraught with emotions, fear and anger among them. This complicated tangle — and the way a person handles it — can reduce the odds that a person will ever re-enter the workforce.

According to studies, employment rates several years after injury hover around 50 percent for severe brain injuries, 35 percent for paraplegics, 25 percent for quadriplegics, just under 70 percent for amputees, and 80 percent for severe burn victims.

Costs are jarring, too. For traumatic brain injuries alone, researchers estimate an economic impact of $56 billion yearly, much of it due to lost productivity.

Experts believe we can do better.

Medical, surgical, prosthetic and technology advances are pushing workers forward. Payers and care management organizations can improve outcomes by putting more emphasis on treating for psychosocial factors.

Set the Tone from Day One

After an injury, it takes time for an injured worker to envision any future. That’s why the psychosocial factors in recovery and return-to-work need to be on the table from day one.

Some might presume that talking to an amputee or a spinal injury patient right away about going back to work would seem callous or create pressure. But most people equate having a job with having a normal life. Talking about work introduces the idea of getting back to normal — even a new normal.

That’s important early on, when the injury seems terrifying. Work offers hope for the future and gives the worker something to cling to when he might otherwise get caught up in “my life is over” thinking.

Marcos Iglesias, senior vice president and chief medical officer, Broadspire

“We’re raised to believe you survive in this world by having a job,” said Zack Craft, vice president of rehab solutions with One Call.

“When you say you may never work again, or don’t know if you can, you have emotional stress and that’s going to impact how you heal and how you think.”

Added Marcos Iglesias, senior vice president and chief medical officer with Broadspire, “One of the things that effective doctors do, and I recommend we claim professionals do, is [to ask] early, ‘What do you like about work?’ It starts getting into the individual’s mind the idea that we’re expecting that they’ll return to work. That work is good for them.”

Setting the stage for return to work can also help counter financial panic.

Said Craft, “[Even if] you’re not worried about today’s bills, you’re worried about your bills in five years. And how are you going to pay for your daughter’s wedding? Are you going to go be able to retire, to travel, and do the things that we all look forward to in our work lives?”

Presented in a positive way, with realistic and achievable steps, talking affirmatively about the path back to work can buoy workers’ health and outlook.

Focusing on the future can be instrumental in helping workers heal from emotional trauma, said Marijo Storment, CEO of ALARIS | Encore.

“There are times when we see injured workers just hang on to the accident or injury so tight that they can’t get past the actual event. That’s a big psychosocial component and can be a [significant] barrier.”

Storment said that workers with traumatic injuries do best when helped to focus on their “new normal.”

The Right Support

The help of an experienced case manager is essential. Beyond coordinating an injured worker’s treatment and physical transition back to home and work, the case manager is in the best position to gauge a worker’s mental state and communicate with the team if a psychologist is needed.

But often, it is case managers themselves who are the primary source of emotional support for injured workers. During a recent webinar hosted by Genex, Jeremy Romero, a former police officer with the Corrales Police Department in New Mexico, spoke about his initial despair after a high-speed chase left him with a spinal cord injury. Romero said his nurse case manager helped to ground him.

As Romero tells it, Genex nurse case manager Trish Elizalde said to him upfront, “I don’t know you yet, but I’m not going to let you give up.”

Elizalde helped Romero understand that as serious as his injury was, “it didn’t mean my career was over, it didn’t mean my life was over.”

“My case manager was my constant support, constant backbone,” said Romero. “Without that, I wouldn’t be where I am today; I am 100 percent certain of that.”

Case managers also support the injured worker’s family, which can help ease worries about how they are coping. Having support helps families set aside their own fears so that they can encourage and care for the injured person.

Matching the injured worker with the best possible rehab facility is also crucial.

“At most centers of excellence … I think there’s more advanced thinking in terms of including psychosocial risk factors in the diagnosis and the assessment even in the earlier treatment,” said Iglesias. “At centers of excellence, they tend to know that [a traumatic injury patient] needs behavioral health support on day one — it’s not an afterthought.”

“There are rehab facilities that are going to be more in tune and provide more extensive psychosocial work toward redefining normal for that injured worker,” said Storment.

A specialized facility can also offer a sense of perspective, and the benefit of seeing others progressing on their journey, said Craft.

“A lot of these regional facilities, they have one or two spinal cord patients in the hospital. You go to the Shepherd Center you’ve got dozens of patients in their outpatient facility,” It’s a lot harder to get stuck in a negative or catastrophic mindset you’re surrounded by hurt just as bad or worse, who are pushing through and keeping a positive attitude, said Craft.

Prepare for the Bumps in the Road

Once a worker is medically ready to come back to work, there is typically a broad range of accommodations and other factors to be addressed to facilitate a successful transition.

Whether a worker comes back to the same job, or to a different job at the same company, or to another job altogether, the case manager will ideally be the one to communicate with the employee, the employer and the treatment team and assure a fit that works for both employer and employee.

Zack Craft, vice president, rehab solutions, One Call Care Management

“We want to make sure when they go back … they’re doing work that they see as valued,” said Storment. “The injured worker doesn’t want to be there just to check a box.”

The work environment can present challenges for a worker’s new needs. Some workers might need a private place to administer medication, for example.

With a spinal cord injury, there are bowel and bladder issues to be considered. A quadriplegic could have specific feeding needs. Such situations may not always have easy answers.

Consider, for example, an amputee who needs to take his prosthetic off from time to time, said Craft.

“That prosthetic gets hot and gets heavy. Your skin itches and you say, ‘I want to take that thing off,’ and suddenly everybody’s all, ‘Oh my, you just put your hand on the table!’

Not every employee is emotionally stable or emotionally mature enough to handle that type of situation. How do they address that?”

Part of it, he said, is reaching out to that employer and preparing them and saying to them, “He’s going to come back different, there are going to be complications. There are going to be some things that need to be addressed, to be aware of.”

“We have to really be proactive,” said Storment. “We’re not going to solve every barrier before we get there. But if we try to create a clear path, that return-to-work milestone is going to be much more successful.”

Opportunities for Faster Engagement

To accommodate workers whose needs might be too difficult or uncomfortable to manage within the workplace, working from home could be a viable option.

“Ten years ago, an individual with a spinal cord injury’s return to an office environment was wrought with obstacles,” said Craft, “both because of the physical challenges and difficulties engaging with the rest of the workplace.”

“But fast forward to today. Say a top salesperson was in a [work-related] car accident and there’s a spinal cord injury. They’re not ready to return to work emotionally and physically, or the company may not be ready for it. Today, the scenario could be, ‘Let us set up your home office.’

“We’re not pushing individuals that way yet today, but that’s where I would like to go,” he said.

“We want to bring them back into the company as fast as we can – no matter what it is they can do – and it doesn’t have to be a lot.”

First Change Industry Mindset 

Part of the challenge, said Craft, is getting other stakeholders to think differently about how they handle catastrophic injury cases. Too many people across the industry think “Oh it’s a spinal cord injury. He’s not going to return to work,” said Craft. “They see it catastrophically.”

It’s important to have a strategy, have a goal, and track that goal, he said.

“Let’s put a date out there and let’s make everybody accountable. These individuals should return to work to some level,” he said.

Broadspire’s Iglesias is in agreement. “Have a written plan. Identify the stakeholders, identify the possible jobs and tasks that are available. Identify where the individual is today and where [the treatment team] thinks he might be in X number of weeks.” &