Should Treating Psychosocial Factors Be the New Normal?

Ever wonder why some injured workers return to work relatively quickly while others with similar injuries linger off work much longer or maybe never return to work? Ever wonder why some employees seem to cope with pain so much better than others with the same diagnosis? So have many others, which is why there have been numerous studies on these issues over the past 20-plus years.

Psychosocial factors – a new buzzword in workers’ compensation – refer to a patient’s psychological and social issues that affect their recovery from the physical or biological injury. While many patients develop psychological problems as a result of their injury, they might have psychosocial issues from day-one that interplay on their recovery.

There has been a recent trend by some in the workers’ compensation arena to pay close attention to these factors from the onset of a claim up until the end. These insightful individuals have come to understand that treating the physical injury only and ignoring the other issues in the injured worker’s life can be short-sighted. Instead, they look at the psychological and social aspects of the worker and attempt to determine which of these things might affect their recovery. If appropriate, they will apply the necessary resources to address the problems and, hopefully, speed up the recovery and return to work.

Tools

Questionnaires have become a popular tool to look for and identify issues that might have a bearing on an injured employee’s recovery time from a work injury. These can vary from a five-question Screener and Opioid Assessment for Patients with Pain (SOAPP) to a more detailed Orebro Musculoskeletal Pain Screening Questionnaire. These assessments typically are used to identify employees that are at high risk for responding poorly to the common medical treatment regimen. Not only can these questionnaires be used in the early stages of a claim, but they can also be used later with a goal of addressing psychosocial factors as soon as possible before the recovery is sent off course. Some of the areas that these questionnaires measure are:

• Pain attitudes, beliefs and perceptions;
• Perception of work;
• Mood/affect, catastrophizing;
• Behavioral response to pain; and
• Activities of daily living (ADLs).

These questionnaires attempt to identify the probability that injured employees might develop problems during their recovery process.

Examples of factors that might contribute to an employee’s risk for recovering poorly are:

• History of drug or alcohol abuse;
• Work dissatisfaction;
• Family, legal or financial problems;
• Low expectations of recovery;
• Disabled spouse or young children at home;
• Low wage earner; and
• History of depression or moodiness.

Low- and moderate-risk individuals can usually be managed with proper education but high-risk candidates might require additional resources to prevent them from becoming long-term chronic pain or disability patients. The intent of the process is to identify and manage the cognitive, behavioral and psychosocial factors that interfere with recovery from the employee’s physical impairment.

One treatment protocol that is gaining traction in the workers’ compensation arena is Cognitive Behavioral Therapy (CBT). This treatment focuses on techniques to change thinking patterns that might adversely affect the patient’s response to pain, such as getting the injured worker to change their view of an injury from overwhelming to manageable. It might also teach behavioral skills like relaxation or biofeedback in an effort to assist them to self-regulate psychosocial stimulation as well as pain.

These tools can teach injured workers to monitor maladaptive thoughts and substitute them with positive thoughts. Most importantly, it should be used to convince the employee that treatment is relevant to their problem, and that they need to be actively engaged in the process. If they don’t buy into the treatment regimen then the results can be poor, regardless of the appropriateness.

Concerns

Claims handlers sometimes have concerns over adding a psychological component to the claim process. While this might be a legitimate concern, if handled appropriately, it can be avoided.

There are two current procedural terminology (CPT) codes that can resolve the issue, CPT 96150 (the initial assessment of the patient to determine the biological, psychological and social factors affecting the patient’s physical health and treatment problems) and CPT 96152 (the intervention service provided to modify psychological, behavioral, cognitive and social factors affecting the patient’s physical health and well-being).

No psychiatric diagnosis is required for the psychologist or psychiatrist to receive authorization for treatment or payment, and the unwanted psychiatric claim is avoided.

While there are many tools in the claim handler’s arsenal, addressing an injured employee’s psychosocial issues and applying the appropriate resources to manage them is one that has rarely been used in the past but is becoming more popular today. This is arguably due to the favorable results delivered. Likewise, CBT is also becoming more common to control some of these issues once identified.

Claims handlers that are not currently employing this approach might be well served to investigate this further. Examining psychosocial factors could prevent claims from veering off track or assist in helping others to get back on track.