Mind-set is Key to Quick Recovery
Psychosocial barriers “account for 30 percent of variance in the magnitude of disability,” said Ruth Estrich, chief strategy officer at MedRisk and the moderator of “Overcoming Psychosocial Barriers to Recovery” a session presented at the 2014 National Workers’ Compensation and Disability Management Conference & Expo in Las Vegas.
There are four major psychosocial barriers that impact workers’ compensation cases, according to the experts on the panel, which also included Sherri Burrell, head of operations, Briotix Inc., and Carrie Freeland, manager, integrated leave department, Costco Wholesale.
The first is “catastrophizing,” or assuming that the worst will happen. The second is perceived injustice, or believing “I don’t deserve what is happening to me.” The third barrier is fear/avoidance, or believing that physical activity will aggravate an injury, leading a worker to disengage from daily life activities. The fourth barrier is negative beliefs about disability.
“What you believe about your disability has a huge impact on how you handle it and what your outcome will be,” Estrich said. “If expectations are negative, your reality will be negative.”
Progressive Goal Attainment Programs (PGAP) are an effective way to get at-risk injured employees back to work, and have a 77 percent enrollment success rate and 60 percent return to work result, according to the panel.
PGAP pairs a worker with a certified consultant once a week for up to 10 weeks. The consultant, who often has a background in occupational or physical therapy, provides the worker with a daily schedule of structured activity and clear goals, which promotes re-engagement with daily life and combats depressive symptoms.
Burrell, whose company provides trained PGAP clinicians, noted that not every success story results in a return to work; someone who can perform everyday tasks and re-engages with life is considered a success.
Once a PGAP-eligible case is identified, employers reach out to an injured worker’s treating physician for a referral.
While most physicians are on board, others aren’t so keen. Attorneys of workers, adjusters “entrenched in their own procedures,” or the employees themselves can refuse to participate, Freeland said.
Those who do enter the program often improve vastly. Costco, one of a few major employers to implement PGAP, has run two pilot programs, Freeland said. One employee had been out of work for over a year with a cervical sprain. She was told not to lift more than five pounds.
Costco had been ready to cut her off and litigate, but decided to offer the PGAP program as a last-ditch effort. At the end of the 10-week period, her functional capacity had increased to 40 pounds and she was back on the job.
“This was someone who had been written off completely,” Freeland said.
Costco now plans to expand their program and incorporate non-occupational disabilities.