Catastrophic injuries are typically complex and require the identification and implementation of very high level care. This will likely include psychological support to address the event, the injury itself, the healing process and life after recovery. The psychological impact of a life altering injury is significant and providing appropriate resources to address adjustment to injury issues is an essential component of the rehabilitation process.

Successful case management will incorporate a comprehensive biopsychosocial approach. Identifying and coordinating multiple physicians and specialists in both the acute and post-acute phases of care is essential for the individual to achieve medical and psychological stability. By addressing the whole person’s needs and fostering a sound support structure, the care manager and treating providers increase the likelihood of achieving optimal medical and financial outcomes.

The Traditional Approach

The traditional biomedical approach to recovery from injury in clinical practice does not achieve the best results in helping injured workers return to work (RTW) after occupational injuries. Providers can no longer presume that simply fixing the body’s physiology or pathophysiology will automatically return the injured worker back to pre-injury status. Both the medical and workers’ compensation communities acknowledge that many factors other than human body physiology will impact disability and ultimately RTW capability.

The Biopsychosocial Approach

The crucial concept to keep in mind when trying to help an injured worker make a full recovery and return to work is the idea of the “whole person.” A healthcare provider and claims manager who take this holistic and comprehensive approach to understanding the injured worker will increase the likelihood of achieving RTW status and decrease the likelihood of long term disability and the associated costs.

Practitioners generally recognize four domains of behavioral health function that impact return to work: social interaction, behavioral control, mood and emotion, and self-efficacy (Factor Analysis: Behavioral Health Function. Archives of Physical Medicine and Rehabilitation. 94:1675). In other words, when a person feels empowered, is able to control impulses and frustration, can adapt to changing circumstances, and has the support to cope with stress, that person is better able to focus on healing and reach RTW status.

A content model for work-related behavioral health functions was recently explored over a series of articles in the Archives of Physical Medicine and Rehabilitation (2013; 94:1645-52). These researchers identified five major domains: behavior control, basic interactions, temperament and personality adaptability, and workplace behaviors. The goal of this research was to develop an instrument for systematically assessing physical and behavioral characteristics and abilities required for successfully returning to work.

Red Flags

Paradigm Outcomes suggests paying particular attention to three areas that have the potential to disrupt rehabilitation:

• Alcohol and substance use and abuse: Almost 2/3 of people who have sustained a traumatic brain injury (TBI) have a history of alcohol abuse or risky use, and more than half of survivors of TBI will become depressed within a year of injury according to Traumatic Brain Injury Model Systems National Data and Statistical Center (TBINDSC).
• Legal, financial and guardianship issues: A designated party should be identified to assist with managing resources and making crucial decisions about the injured person’s long term needs.
• The aging workforce: Older injured workers may have additional challenges in terms of length of recovery, functional independence and appropriate long term living environments. They are also at increased risk for medication/substance abuse.

Additional Support

The International Society for Traumatic Stress Studies, a division of the American Psychological Association, identifies and evaluates the efficacy of tools for assessing trauma related psychological issues. Visit their website for a variety of assessments and self-report tools, including the Clinician Administered PTSD Scale (CAPS), Acute Stress Disorder Scale (ASDS), and the Trauma History Scale (THS).

Catastrophic injuries require advanced care coordinated by an experienced case manager. At Paradigm Outcomes, our Network Managers are experts in managing complex claims and facilitating access to acute and post-acute treatment to address the biological, psychological and social impacts of trauma. This comprehensive approach is essential to helping an injured worker achieve an optimal level of recovery.

Join us in our next blog post where we’ll take a closer look at the ways a catastrophic injury impacts the injured worker’s caregivers and family members. To learn more about Paradigm Outcomes and our strategies for complex case management, you can check out our website or follow us on Facebook, Twitter, and LinkedIn.