Aimee Peters, LCSW, Chief Clinical Innovation Officer at Ascellus
Historically, claims adjusters have been hesitant to address behavioral health components related to physical injury claims for workers’ compensation. The reasoning being that physical-only claims generally have more predictable timelines and adding a psychological (psych) component to a physical injury claim complicates anticipated outcomes such as duration of the claim, as psych issues seemed difficult to quantify and might add to the probability of malingering. In the past, for workers’ compensation, the inclusion of a psych claim was thought to increase costs and the possibility of the injured worker languishing indefinitely with an unseen diagnosis. Now, the sentiment of apprehension about the mere mention of mental health is shifting as employers (and insurers) are looking for ways to address the mental health of workers.
The shift toward integrated behavioral health solutions
As research mounts to evidence the relationship between physical and mental health (which includes emotional, psychological and social well-being), there is a growing recognition in workers’ compensation professionals of the role of mental health in employee productivity, return to work after injury, and a reduction in overall claims costs. The increase in stress, depression and anxiety related to the COVID-19 pandemic has emphasized the need for attention in the area of mental health in the form of not only employee assistance programs, but broadly to include formal behavioral health treatment integral to the work setting.
The theme of integrated mental and physical healthcare, especially in the workplace is now taking center stage, perhaps as a necessity since stressors have increased and it becomes more apparent that chronic pain, financial insecurities, fear and negative thoughts contribute greatly to an individual’s mental health and can have detrimental effects on physical well-being, employee retention and ultimately, business continuity. And while this holistic attitude to wellness has recently grown in popularity, research has long proven the benefits of integrating mental and physical health care.
Early intervention has the biggest impact
Even in physical-only workers’ compensation injury cases, where there is no accepted mental health diagnosis related to the claim, empirical evidence indicates that early, targeted behavioral health intervention can speed injured workers’ recovery and be extremely effective in reducing lost work time as well as workers’ compensation costs.
A study we performed with the employees of a national premium grocery retailer demonstrates the effectiveness of supporting the mental health component regardless of whether there is an additional psych claim. With physically injured employees on workers’ compensation, we ran two tests to determine:
- Whether screening participants using our Pain Screening Questionnaire (PSQ) could accurately identify injured workers who were at considerable risk for lingering in the workers’ compensation system with significant costs.
- Whether administering targeted, time-bound behavioral health intervention to those at high-risk for delayed recovery could change these workers’ anticipated results.
High scores on the PSQ flagged workers with psychosocial risk factors related to recovery. These workers strongly feared the recovery process, as well as re-injury. These patients were then placed in a short-term behavioral health intervention to prevent delayed recovery and strengthen the likelihood of experiencing a timely, positive return-to-work outcome.
The impact of cognitive behavioral treatment for employees
In both tests, the study proved successful. Of the 11,000 injured workers who completed the pain screening questionnaire, 12% scored in the high-risk range for delayed recovery. Of those 12%, half received work-focused cognitive behavioral therapy (W-CBT) and showed marked improvement after an average of six sessions. Results also showed a 50% reduction in total claims costs—an average savings of approximately $37,000 per claimant versus those who did not receive the intervention.
When administered early in the workers’ compensation process, screening assessments that ask patients to rate their pain and gauge the extent to which they believe they face permanent disability help to determine risk factors, which once identified and addressed through W-CBT, can lessen the need for additional or ongoing medical services and lower total claims costs. Research results such as these reinforce the strategy of welcoming a behavioral health component at least in the form of screening and short-term work-focused cognitive behavioral therapy to assist high-risk patients in shifting their negative mental outlook to a more positive perspective and increasing healthy behaviors which has been proven to hasten recovery outcomes.
Physically injured workers with behavioral or emotional issues experience delayed recoveries more often than workers who do not have the added psychological component. As research demonstrates, when early screening for delayed recovery is provided and workers’ behavioral needs are addressed through targeted, brief, work-focused cognitive behavioral therapy, the results prove substantial for injured workers and the workers’ compensation system through better claims outcomes.
About Aimee Peters
Aimee Peters, LCSW, is the Chief Clinical Innovation Officer at Ascellus. Peters has nearly 25 years of clinical expertise, strategic acumen, product and program development and leadership in the behavioral health industry. She has pioneered virtual behavioral healthcare, increasing access and high quality behavioral healthcare to many of the US’s largest health insurers across all 50 states. Driven by a passion for promoting telehealth adoption, Aimee serves as an adjunct professor at Columbia University School of Social Work where she developed the University’s Telemental healthcare curriculum.
Ascellus is the leading behavioral health platform focused on helping injured workers restore their physical and mental wellbeing. By bringing people and technology together, Ascellus delivers customized treatment options through a national network of 1,500 licensed clinicians, reducing costs for workers’ compensation claims and empowering injured workers to return to work sooner.