issue 001, 2015 q2

Treating the whole person 001

Understanding the relationship between psychosocial issues and return to work

BY Andrea J. Buhl MSN, RN, FNP-BC, VP, Clinically Integrated Medical Programs, Sedgwick

Behavioral health is a growing topic in the workers’ compensation and disability claims industries. For a long time, they focused on the medical management side and did not delve into the psychological side. There are more and more studies supporting the fact that psychosocial issues can impact employees’ pain, functionality – and ultimately their ability to return to work. Many employers, insurers and third party administrators have shied away from addressing psychosocial issues. However, it is important to note that many psychosocial barriers are in existence even before the work-related injury or disability occurs; if these factors are not acknowledged and dealt with, they can significantly impact lost time and medical costs.

When sick or injured employees are off work for long periods of time and they are not improving or their pain is getting worse, we can’t just look at their cases in a silo. We have to dig deeper by looking at possible behavioral issues that may be going on and address these concerns early in the process to help employers ensure the best possible outcomes.

 

 

HOW IT WORKS
At Sedgwick, our strategic case management nurses review the claims that are referred for case management and look for yellow flags, which may identify concerns such as anxiety, fear of returning to work or a history of narcotics use. The nurse will have conversations with the employee to see if there is something that needs to be done a little differently for them or issues that need to be addressed, and determine if they need behavioral health intervention. Our claims specialists are also trained to look for these flags and they can make the referral at any time in the claims process.

 

BENEFITS
Our dedicated behavioral health specialist (BHS) identifies psychosocial barriers and then develops a customized approach for each employee to help address the issues that are preventing them from returning to work. The BHS is skilled in quickly breaking down barriers and fostering an environment of trust with the employee, which can result in reduced litigation in workers’ compensation claims.

Through telephonic conversations, psychosocial barriers to return to work are addressed. Additional resources, including private health and employee assistance programs (EAP), can be leveraged to ensure the employees receive the care they need even after they have returned to work and the BHS is no longer engaged.

For employees who do not have health insurance through their employer, our BHS will look for resources that are available in their community. Group therapy options or online resources may be available depending on the circumstances. If the employee has medical needs that are not part of the claim, the BHS may be able to find discounted rates for treatment.

Our goal is to identify possible issues that may be causing barriers for the employee and provide the tools to help them get back on track. For example, we may recommend that the employee contact their employer’s EAP program and then follow up to make sure the discussions are worthwhile.

Many times, people who are struggling or feeling depressed over certain situations or have anxiety don’t want to reach out on their own, or they may have trouble getting an appointment set up or following through if there is no one there to check on them. That’s one of the benefits of Sedgwick’s behavioral health program.

Some employers in the retail industry engage EAP staff to come on-site to do a debriefing following a robbery. If employers do not have this type of program, our BHS can follow up and ensure the employees are obtaining the care they need to address any psychological and emotional issues they may have after a traumatic event like this, or one involving personal illness or tragedy.

Sick and injured employees who have been referred to our behavioral health program know they have an advocate who is there to help them overcome the challenges associated with a work-related injury, disability or absence.

Yellow cloth with red words 

BOTTOM LINE
Whether it is a workers’ compensation, disability or leave of absence case, we are treating people. Sometimes that requires thinking outside of the box for claims administrators and employers. Sedgwick has all of these services in house, which makes us more flexible, and we see how all sides can work together effectively for our clients and their employees. Our behavioral health program looks at cases from the medical perspective and from the psychosocial perspective, not just from the workers’ compensation, disability or leave of absence perspective.

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