02/22/2024
The deeply interconnected relationship between behavioral health challenges, psychosocial factors, chronic pain, and workplace injuries deserves attention from stakeholders across the workers’ compensation system. Whether directly related to the injury itself, external forces such as economic or family instability, or a pre-existing condition, untreated behavioral health conditions drive claims volume, spending, and variations in outcomes. Even for high-performing and experienced claims professionals, the administrative burden associated with these cases drains time and resources.
In fact, 3-10%1 of injured workers encounter recovery delays related to behavioral health issues, including chronic pain, and claim costs can be 2.6–6.2 times higher2 when behavioral challenges are present. And one of the biggest barriers to solving these challenges is access to care—injured workers wait an average of 48 days3 for behavioral health services. Overcoming these obstacles not only requires an established, day-one process that identifies risk factors and promptly coordinates care, but also experts in place who understand the crucial role played by families and community resources throughout the recovery journey.
Understanding the challenges of behavioral health and pain management
Chronic pain is one of the most serious and widespread symptoms associated with workplace injuries of any diagnosis, and there is a growing understanding of its connection to behavioral and mental health. Psychosocial factors, including pre-existing mental health issues and turbulent home environments, have an important role in the onset and severity of chronic pain for work-related injuries.
These warning signs are often associated with a progression toward depression, anxiety, substance abuse disorders, and other issues. Not only can behavioral health problems exacerbate chronic pain, but the presence of chronic pain can increase the risk of behavioral health challenges developing.4 Either of these circumstances has the potential to significantly derail recovery, delay return to work, and increase claim costs.
This is why identifying behavioral health concerns from the outset is critical. Family dynamics, economic status, education, culture, and relationship with the employer can all indicate who needs further evaluation. When intervention is required for the patient or family, these cases invariably require in-depth service coordination—locating evidence-based practitioners, scheduling visits, tracking visit adherence, and critically reviewing medical records and treatment plans.
For injured workers with complex and catastrophic injuries and conditions, the challenges are even greater. Catastrophic and severe injury diagnoses are often accompanied by complex pain and serious behavioral conditions. There is a greater risk of severe psychological issues and exacerbation of pre-existing behavioral and psychosocial problems in cases with less clear pathways to maximum medical improvement (MMI) and release to return to work (RRTW). More than anything, these injured patients need access to people and support structures equipped to handle these challenging conditions.
Paradigm’s proven behavioral health solution
Paradigm has spent decades building a proven, formalized process to provide hands-on behavioral support for catastrophic and severe workplace injuries based on specialized expertise, a team-driven model, evidence-based assessment, and strong clinical partnerships. This model is fully integrated into every Paradigm HERO Catastrophic® Outcome Plan.
The process begins with a thorough in-person psychosocial and behavioral assessment immediately at intake. Standard assessment tools include structured interviews, the Patient Health Questionnaire (PHQ-9) to measure depression severity, the General Self-Efficacy Scale to predict coping and adapting after stressful life events, the Kingston Caregiver Stress Scale to assess family/caregiver burden/strain, and a biopsychosocial indicator score to identify pre-existing psychological or substance use conditions, social determinants of health, and other factors that could affect the care journey. By establishing baseline indicators early, care managers can determine if immediate action needs to be taken. When behavioral intervention is needed, the Paradigm Management Team assigned to the case is uniquely equipped to coordinate necessary services and support to both the injured worker and the family.
Each team has access to Community Support Specialists—behavioral health professionals specially trained to offer support, coping strategies, and resources for workplace injuries. Because it takes strong community and family support to give seriously injured workers the best chance at a better life, Community Support Specialists are dedicated to proactively identifying vital community resources that support recovery. These can range from mental health or substance abuse counseling, to financial and nutritional assistance, to childcare and identification of affordable housing options.
Paradigm also relies on an in-house roster of board-certified psychiatrists, psychologists, rehabilitation counselors, and applied behavior analysts who promote positive psychosocial adjustment and address potential barriers to recovery. The goal is to match specialists and support that best fit the individual needs of each injured patient and their family. This means the availability of male and female professionals, bilingual support, and specialists with injury-specific background and experience who are assigned based on their unique expertise to address the issues connected with each situation.
Community Support Specialists are one component of the Paradigm Management Team, consisting of Paradigm Medical Directors, Network Managers, Clinical Specialists, and Directors of Clinical Solutions. These high-functioning team members have the resources and knowledge to understand the complex relationship between physical injury recovery and behavioral and psychosocial recovery.
The final piece of the puzzle is Paradigm’s curated network of best-in-class behavioral health providers. Fostering strategic partnerships with facilities and providers that employ evidence-based practice approaches and conduct published, peer-reviewed research ensures that injured workers and families will receive seamless continuity of care, focused on a mutually agreed-upon set of biopsychosocial outcomes.
In each HERO Catastrophic Outcome Plan, the team actively tracks personalized milestone metrics that include both functional and behavioral health benchmarks. Reaching the targeted outcome means achieving residential and community integration goals and having a stable long-term care plan in place. By working together, Paradigm Management Teams and clinical partners ensure that injured workers and their families will get the hands-on social and behavioral health support they need to thrive, while clients receive the guaranteed outcomes only Paradigm can deliver.
Expanded impact for a changing behavioral health landscape
In addition to the support for catastrophic cases, injured workers with primary or secondary behavioral conditions such as chronic pain or psychological disorders can still benefit from enhanced support, even when a catastrophic injury is not present. Behavioral Health Clinical Management is a time-based, fixed-price solution that fully leverages Paradigm’s proven behavioral health model. Our experts create goal-based recovery plans for conditions ranging from depression and anxiety disorders to post-traumatic stress disorders, sleep-wake disorders, and chronic pain—which are keeping injured workers from fully engaging in productive, meaningful life/vocational routines.
A dedicated team of behavioral health and pain management clinical professionals starts by assessing and clarifying the behavioral health diagnosis and appropriateness of treatment. Using structured, interdisciplinary methods focused on identifying and achieving key behavioral health milestones, this solution achieves improved function and self-management of residual symptoms, with a focus on MMI and RRTW. Ultimately, injured patients are guided toward decreased reliance on pharmacologic or interventional treatment, while reducing the cost and duration of disability.
Focusing on behavioral health makes a difference
Paradigm offers expansive capabilities and expertise to meet the broad range of behavioral health needs of the injured workers and families we support. By having the flexibility to match the right people and resources based on the unique needs of each case, we keep people at the center of the recovery journey. Whether behavioral needs are directly related to the injury; grow out of social, economic, or family issues; or are exacerbated by pre-existing conditions, Paradigm has the expertise and experience to work within the home, family, and community to give the support each injured worker and family needs.
Learn more about how Paradigm is uniquely positioned to proactively support your case managers and claims professionals on these challenging cases—and why our commitment to an outcome-focused, community-driven, biopsychosocial approach to catastrophic and complex injury management makes such a difference for the clients and injured workers we serve.
Share
Share
Tweet
Email
