I have been working as both a Psychologist and Vocational Rehabilitation Consultant for over 20 years (saying that makes me feel very old by the way). I have to admit that one thing that really annoys me when getting a referral as a Psychologist is when the referrer says to me “It’s been 2 years and we’ve tried everything else to get this injured worker back to work and so we hoped you could work your magic”. Hmmm, well let me just pull that magic wand out of my handbag and wave it around a few times, sprinkle this injured worker with pixie dust and hope they will be open and trusting enough to listen to some opportunities to manage their pain and address psychosocial issues preventing their return to work. Unfortunately it does not often have a successful outcome when you consider they have had two years (or more) trying to manage pain (probably with the use of a number of medications), had numerous attempts at returning to work (some more successful than others), and have become entrenched with their behaviour and habits with respect to management.
The ABC recently wrote an article regarding the lives lost as a result of multiple drug use. A 43 year old woman died and in her bedroom was found more than 50 boxes of prescription medication including Endone, Methodone, Ibuprofen, Stilnox, Lyrica, Endep and Panamax. An inquest into her death found that she had died from acute multiple drug toxicity. See full article here.
Australasian work injury data on those who have not returned to work by 6 months post injury indicate that 84% of those who do not feel ready to return to work relate this to their injury/pain (Campbell Research and consulting 2005/06)
There are also many risk factors we know of which increase the likelihood of the duration of a claim, including duration of pain experienced, intensity of pain, more days of reduced activity, psychological symptoms of anxiety and depression and that the injured worker believes their pain is likely to persist.
We also know that there are a number of flags which are indicative of delay in recovery including:
· Red flags (biological) – Serious pathology and co-morbidity.
· Yellow Flags (Psychosocial) – Depression, unhelpful coping strategies (resting and avoidance), emotional distress, passive role in recovery
· Blue Flags (Work factors) – Perceived low social support at work, perceived unpleasant work, low job satisfaction and perception of excessive demands,
· Black flags (systemic) – legislative criteria, nature of work place and compensation system.
Given all these insights, couldn’t we be introducing the opportunity to provide injured worker’s skills to manage their pain before it becomes chronic and adopt strategies to enhance their wellbeing earlier in their management and treatment?
Professor Michael Nicholas conducted the WISE (Work Injury Screening and Early Intervention) Study (2011 - 2012). He recognised that through early identification (via Orebro Musculoskeletal Pain Screening Questionnaire - OPMQ) of injured workers in a high risk category, a multidisciplinary approach (General Practitioner, Physiotherapist, Occupational Physician, Psychologist) could be instigated within 1 week after an injury was sustained with significant beneficial outcomes.
The key roles for Psychologists in this study involved assessing personal and environmental obstacles for return to work, engaging with and helping the injured worker deal with obstacles and liaising with all key parties often including claims managers and RTW Coordinators. The outcome of the study showed the intervention group had less time off work and that this was sustained.
The WISE study demonstrated that Psychological intervention was particularly successful, with injured workers showing decreases in OMPQ scores, decreases in distress, disability perception and worry and increases in confidence post psychological intervention. See full outline and outcomes of study here.
So what can Psychologists offer within the first few days and weeks after a worker sustains an injury?
1) Assist to manage expectations of injury, recovery, treatment and pain.
2) Provide strategies to successfully understand and manage pain.
3) Manage typical avoidance behaviours and the perceived need to rest following a work injury.
4) Management of appropriate routine and sleep hygiene.
5) Address worry and potential anxiety regarding the return to work process and address any obstacles or barriers to return to work.
6) Address automatic negative thoughts and review opportunities to engage in thinking that enhances confidence in self-management.
7) Assist the injured work to manage strategies for effective communication with their Mobile Case Manager, employer and medical practitioners.
8) Manage any potential conflict more successfully rather than engage in less helpful behaviours which can impede successful return to work.
9) Assist to map out an active (rather than passive) coping strategy.
10) Manage adjustment to post injury capacity and impacts on lifestyle.
If you would like to know more about the opportunities for psychological early intervention, please contact Michelle at email@example.com or 0412047590.
Michelle Bakjac is an experienced Psychologist, Organisational Consultant, Leadership and Wellness Coach and Trainer/Facilitator. As Director of Bakjac Consulting, Michelle has been working in the area of workers compensation and return to work management for over 25 years. Michelle assists individuals to develop strategies to develop their resilience and mental toughness to improve performance, behaviour and wellbeing. You can find her at www.bakjacconsulting.com or firstname.lastname@example.org