Return to Work Forum Return to Work Forum –– 2929thth--3030thth July 2014July 2014

Anya Stephens

Registered Psychologist Co-Director PeopleSense

Anya Stephens Registered Psychologist/ Director

Psychologist for 20 years

Worked in the Injury Management industry for 10 Years

Background in working with the hardest to reach, including Background in working with the hardest to reach, including offenders/prisons, school excludees, drug related issues

Established PeopleSense (WA) in 2005

Focus in EAP (Nationally) and Work Place Rehabilitation (WA)

Grew from 5 in 2005, to 70 employees to in 2014, by focusing quality and successful outcomes

Outcomes for injury have not significantly improved – plateaued

In 2012–13, premiums rose by an average of 25 per cent (2011–12: 18 per cent) to reflect the increasing cost and complexity of claimsclaims

Premium increases will continue until the underlying issues of workplace harm and return to work are addressed.

Comcare Annual Report 2012-2013

Disability support pension is paid to 824 k Australians at an annual cost of $15 billion

Psychological problems becoming the main reason for grant.

By 2035 the number of over-65s is expected to almost double. By 2035 the number of over-65s is expected to almost double.

56% of people aged 50-65 plan to work beyond state pension age

What is Complex Rehabilitation?What is Complex Rehabilitation?

Case Study 1Case Study 1

Predictable Complexity

A 46 year old male in a physical role

Above knee amputation

Mother died the month prior

Long term girlfriend has just left him (found his injury too difficult to deal with)

Employer is reluctant to explore support internally while redeployment options are explored

Case Study Case Study 22

Unpredictable Complexity

35 year old female customer service role

Lower back pain – occurred after lifting 10 kilo boxes in the workplacein the workplace

MRI scan indicate no further damage – diagnosis back ligament strain

Should have been a straight forward case…….

Outcome

Employee identified that she experienced

resistance from her manager in relation to

her Return to Work Program

Employee accused manager of using the term Employee accused manager of using the term ‘malingerer’

Employee developed significant anxiety, disturbed sleep, panic attacks and agoraphobia

Employee submitted a further claim for anxiety disorder

Outcome

Insurer took nine months for decision – during this time, client became financially unstable and was evicted from her homeevicted from her home

Second claim declined

2.5 years later – she finally returned to full-time, pre-injury duties (new work environment/new more sympathetic manager)

Pre-existing vulnerability

Low morale

Disengaged – passive and avoidant

Decision point Decision point

Effective treatment = builds resilience

Ineffective or no treatment = increased medicalisationand increased resistance

Low morale – can quickly turn into something more

Stress and conflict heightens pain arousal

Clients can receive ‘adjustment disorder’ label, or ‘secondary depression’

All parties embark on a process of

trying to work out which parts are

compensable and which parts are

non-compensable

BarriersInjured worker General Practitioner Insurer

Treating specialists (including

Employer

Ignorance

Attitudes

Complacency and apathy

(including

Communication, Communication

The best rehabilitation work is conducted face to face with as many of the interested parties as possible

All parties need to sign up to and engage in positive communication communication

Human Resources personnel must

be involved if there are morale/conflict

issues

Education, Education, Education GP’s and treating practitioners must view the

workplace as part of their patients recovery Managers need to understand the compensation

system and put personal opinions to one side. Good system and put personal opinions to one side. Good line management is key to good workplace health

All parties need to try and understand and treat the whole person

Educating all parties about the strengths, limitationsand boundaries of the compensation system

Early Intervention

Efficient success rates depend on the perceived support from the organisation

Average psychological injury has at least 6 mthgestation period gestation period

Intervention appropriate to the injury – if its worth doing, its worth doing properly

Careful management, early on, can prevent a claim

Internal support for managers to assist them to understand the minefield of workers compensation.

Use Work-Oriented Therapy Complex rehabilitation requires

specialised structured programs e.g. schema focussed CBT

Use external practitioners who view Use external practitioners who view work as part of the treatment and not the only cause

Use work related interventions –empower internal staff as much as possible

Dr. Peter Cotton, clinical and organisation psychologist, 2014

Case Conference with all parties – regularly

Including the General Practitioner in decision making is crucial

Including work representatives is useful, if they are supportive of the injured workersupportive of the injured worker

Rehabilitation providers need to be

confident enough to challenge the

GP if required

Use rehabilitation providers who have multi-disciplinary teams and good supervision structures There is huge variation in the experience, quality and

focus of rehabilitation providers Some cases need a range of professional Some cases need a range of professional

involvement Rehabilitation is a highly skilled area of work. Good

consultants tend to:◦ have an allied health background◦ have been trained in rehabilitation ◦ Have access to ongoing supervision and support

Remember the person in the process

Use a solution focussed, person-centred approach rather than a ‘policy’ approach

Use reasonable adjustment in ways that are focussed on outcomes on outcomes

Try saying ‘yes’, instead of ‘no’

Do not ignore the difficult

Adjustment, conflict, self-esteem, anxiety, depression are all important factors and need to be respected and overcome

If you treat people with a lack of regard, or ignore their concerns, they will resist attempts to rehabilitate

Do not lose the injured person in the process Do not lose the injured person in the process

Try and feel the world from the injured person's perceptive

Questions?

Experts in Workplace and Vocational Rehabilitation and Employee Assistance Programs (08) 9388 9000reception@peoplesense.com.auwww.peoplesense.com.au