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By KATIE KUEHNER-HEBERT, a freelance writer based in San Diego with more than two decades of journalism experience and expertise in financial writing

Employers can accelerate their return-to-work programs, lower costs and improve employee morale in workers' compensation claims if they actively address accompanying psychological issues.

If employees experience trauma on the job such as robberies or co-worker deaths, for instance, employers should offer crisis counseling immediately to lower stress reactions and minimize the onset of greater psychological problems, according to Bruce Blythe, chairman of Crisis Care Network (CCN) in Grandville, Mich.

While most companies do not hesitate to send injured workers to the emergency room after traumatic events for physical injuries, many are reticent to deal with any resulting psychological issues for fear they would "buy a psych claim," Blythe said.

The key to minimizing such claims is to immediately get trauma stress coaches to talk to employees, he advised. Part of the process involves getting the employees to retell the traumatic event numerous times to reduce anxiety surrounding the memories of the event and therefore minimize painful "flashbacks."

"We approach the people very, very quickly when they are experiencing normal reactions to traumatic events, and we address both the mental as well as the physical issues," Blythe said. "That helps reduce the potential that they'll develop post-traumatic stress disorder or attitudinal problems that could result in them quitting and wanting to litigate if these problems are left untreated."

One of the companies that uses CCN's services is Family Dollar Stores Inc. of Matthews, N.C., which began working with CCN in 2004 to improve employee retention and reduce worker's comp claims that resulted from traumatic events, such as robberies, assaults or natural disasters, said David Smith, the firm's regional vice president of risk management.

In 2007, Family Dollar added another step: services from Behavioral Medical Interventions (BMI) to provide comprehensive services to employees who had not returned to work after CCN's initial intervention or who had suffered serious injuries.

Family Dollar now experiences a 86 percent retention rate if its employees receive professional support within two to 24 hours after a traumatic incident. Only 6 percent of those cases progress to become worker's comp claims, which tend to be 15 percent less costly than the firm's other claims on average, Smith reported.

"But more than that, providing traumatic stress counseling is doing the right thing for your employees," Smith said.

BIOPSYCHOSOCIAL SUCCESS

According to Daniel Bruns, a health psychologist and president of Health Psychology Associates in Greeley, Colo., there's a growing use of the "biopsychosocial" approach to managing disability, in which biological, psychological and social factors are all taken into account during treatment.

The science suggests that this alternative approach in many cases may be superior to using the "biomedical" model, which is based on the notion that medical symptoms are caused strictly by pathophysiology, Bruns said.

Studies have shown that individuals abused in childhood tend to have stronger stress reactivity, which is associated with delayed wound healing. Other research has found that stress hormones increase the risk of death from infections in intensive-care units at hospitals.

Moreover, serious illness or injury can cause depression or anxiety, which in turn can cause real physical symptoms and poor health behaviors, he said.

Because of this, among those with disabilities, psychiatric disorders are common.

The whole point to the biopsychosocial model is to reduce workers comp costs, Bruns said.

"There is a misconception that if companies refer somebody to a psychologist, it would just open a Pandora's box, and all sorts of psychological complications would just add to the cost. But it turns out the reverse is true," Bruns said. "Often when people don't get better, it's because Pandora's box is already open, and there are a variety of nonmedical reasons why the person isn't going to back work. The purpose of a psychological evaluation is to figure out those roadblocks, deal with them and get them back to work."

Case in point: Bruns and others recently studied the cost savings in workers' comp claims in Colorado over a 15-year period, after that state in 1991 enacted a law that mandates the use the biopsychosocial model. Analyzing cost data from the National Council on Compensation Insurance Inc., the study uncovered that the mean medical treatment cost per case for workers' comp cases in Colorado fell 24 percent from 1992 to 2007, while the mean cost nationwide rose 38 percent.

Other states such as California, New York, Texas and Kansas have mandated that workers' comp treatment providers follow the biopsychosical treatment guidelines by the American College of Occupational and Environmental Medicine (ACOEM) or the Official Disability Guidelines produced by the Workloss Data Institute.

The ACOEM guidelines suggest referring medical patients for psychological assessments, among other red flags, when:

-- Psychological dysfunction is observed or suspected.

-- There has been inadequate recovery, a failure to benefit from all medical treatment or symptomatic complaints that cannot be explained by the patient's physical findings.

-- Substance abuse and/or aberrant use of prescription medication is suspected.

THE CHRONIC-PAIN PIECE

Workers comp treatment providers should pay particularly close attention to psychological issues in cases where the employees experience chronic pain, added Michael Coupland, a psychologist and consultant with BMI.

In 70 percent of the cases where the workers' subjective complaints outweighed objective signs of pain, workers have some type of personality disorder, such as histrionic, borderline or antisocial disorder, Coupland said.

The six most common nonmedical factors associated with chronic pain are attitudes and beliefs, work attitudes, psychological distress, illness behaviors and activities of daily living.

Coupland said that the use of cognitive behavior therapy in chronic-pain cases can minimize extended workers' comp claims and save costs.

"But the treatment needs to focus on attitude and behaviors--even cognitive behavioral therapy can fail if it is focused on the pain," Coupland said.

September 1, 2010

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