Psychosocial Issues in Catastrophic Injuries: Managing the Risks and Challenges

Paradigm − August 24, 2017 − filed under Events

If not actively addressed, the psychosocial challenges that accompany traumatic work-related injuries can interfere with recovery.

Participants in Paradigm Outcomes’ recent webinar learned how case management teams can assess and intervene to mitigate the negative impact of these issues on injured workers’ recovery and functional outcomes.

Paradigm Chief Medical Officer Michael Choo, M.D. and Paradigm Senior Director of Clinical Services Deborah Benson, Ph.D. discussed innovative tools and approaches to address psychosocial issues associated with catastrophic injuries.


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Research and day-to-day experience confirm that patients with psychosocial and mental health conditions have worse physical health and higher medical complications than those without these challenges.

Nearly 1 out of 4 people in the general U.S. population has a mental health condition. Nearly 6% have a severe mental health condition, according to a Congressional Research Service Report to Congress in November 2016.

In the workers’ comp industry, psychosocial co-morbidities were listed as the No. 1 obstacle to achieving desired claim outcomes in a 2016 Workers’ Compensation Benchmarking Study.

 Psychosocial Risk Factors vs. Mental Health Conditions

Psychosocial risk factors encompass attitudes, beliefs, perceptions and emotional reactions.

In contrast, mental health conditions are diagnosable according to the DSM Axis I and Axis II.

Industry research indicates that the presence of a mental health condition predicts a longer duration of work absence. Claims duration for low-back and upper-extremity musculoskeletal conditions were shown to increase dramatically with mental health conditions in a study by Renée-Louise Franche, Ph.D., a consultant in work disability prevention and occupational health.

A recent literature review of catastrophic injuries outlines the prevalence of mental health challenges in survivors of spinal cord injury, traumatic brain injury, burns and amputation.

These mental health conditions and psychosocial risk factors are linked to statistically significant increases in medical costs, duration to achieve outcomes, one-year readmission rates, and decreased return-to-work rates. The effect increases with the number of mental health conditions and risk factors.

Impacts of These Challenges on Workers’ Comp Claims

For injured workers and industry professionals, psychosocial and mental health challenges:

  • Intensify and/or prolong treatment
  • Interfere with participation in rehab
  • Interfere with ability to manage/direct care
  • Increase costs
  • Result in suboptimal outcomes

Injured workers can experience a multitude of psychosocial and mental health challenges, including pre-existing issues, adjustment to injury challenges, family and cultural factors and legal/financial factors.  Occupational issues include work motivation, chronic pain and resilience.

Applying Paradigm’s Systematic Approach

Our steps in managing psychosocial and mental health challenges mitigate their negative impact on the injured workers’ functional outcomes:

Assessment begins with comprehensive screening and evaluation of the injured worker. Next, we use Paradigm’s Psychosocial Behavioral Complexity Calculator, a predictive model that facilitates risk stratification as early as possible. Then, we evaluate the psychosocial behavioral risk drivers and apply a statistical model built on Paradigm’s catastrophic injury database. Combining all these factors, we determine whether the psychosocial behavioral and mental health impact on the care plan is high, medium or low.

The record review, interview and formal evaluation of the injured worker identify current emotional, adjustment or behavioral challenges, and/or pre-existing history of psychosocial red flags.

Psychosocial interventions are customized plans and evidence-based health and behavior interventions. These may involve Cognitive Behavioral Therapy, mindfulness-based therapies, Eye Movement Desensitization Reprocessing (EMDR), family/caregiver interventions and TeleTherapy.

Our outcome evaluation measures treatment efficacy and endpoints as well as justification for ongoing treatment and outcomes durability.

The webinar closed with a case study of an injured worker with severe TBI due to fall from a ladder. Paradigm’s clinical team used their unique model to mitigate the impact of his history of regular marijuana and alcohol use and interlocking psychosocial and mental health conditions that interfered with recovery.

Paradigm’s approach identified his current psych challenges, relevant prior history and future risks; then facilitated admission to an acute neurorehab program and advocated for a transition to a post-acute residential TBI program. The next step was to facilitate a neuropsychology provider, chemical dependency provider, and support services for engagement in volunteer/pre-vocational activities. Monitoring for functional and behavioral stability and contingency planning is ongoing.

Injured workers with complex pain have comorbidities, expectations, habits and coping styles. Steven Moskowitz, M.D., senior medical director, Paradigm Outcomes and Evelyn Bonilla, director of clinical services, Paradigm Outcomes, discuss how to improve recovery by applying a systematic behavioral change approach.

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