Work comp doc: ‘Look at patients holistically’

Counseling, coaching help patients overcome ‘behavioral barriers’ to recovery

By Tony Gottschlich, Public Information Officer

The human body is more than a machine. And when it breaks down, simply repairing the parts won’t get it running again, especially when fear and poor coping skills are involved.

That was the message Friday from the chief medical officer for the Ohio Bureau of Workers’ Compensation (BWC) during a lecture entitled, “Integrating Behavioral Health into Injury Treatment,” at the Greater Columbus Convention Center.

“We need to look at patients more holistically and we need to have the tools to do that effectively,” said Terrence Welsh, MD, speaking at the fourth annual Ohio Workers’ Compensation Medical & Health Symposium. “If we don’t do that we are missing the boat, and we’re not going to accomplish what we set out to accomplish – getting our patients healthy again and back to work and life.”

Speaking to an audience of health care practitioners from across the state, Welsh said health care providers must incorporate a multifaceted approach to better understand and treat patients struggling to recover from injury. He said a “bio-psycho-social” model of care, “accepts that the mind and body influence each other.”

Welsh spoke of a tool BWC initiated last year called the Health and Behavioral Assessment and Intervention services rule, or HBAI. Under the rule, the agency will pay for counseling and coaching sessions that help injured workers overcome negative thinking, poor coping skills, lack of motivation and other behavioral barriers to recovery.

“These things actually work,” said Welsh, who is board-certified in physical medicine and rehabilitation, electrodiagnostic medicine and pain medicine. “There is evidence these services can improve outcomes.”

He cautioned the rule does not apply to mental illness and psychological disorders, but to naturally occurring emotional responses that many people experience following a serious injury.

In an interview before his lecture, Welsh said research shows behavioral barriers have three times or more the impact than pain alone in slowing an injured person’s recovery. That’s why it’s important to address barriers before they spiral into something more serious, such as depression and substance abuse.

Barriers that have the greatest impact on delayed recovery include:

• Catastrophic Thinking: The tendency to ruminate about irrational worst-case outcomes. This can increase anxiety and prevent the injured worker from taking action, such as completing their rehabilitation treatment program.
• Perceived Injustice: The injured worker’s belief that nothing will ever make up for what happened to them, and they didn’t do anything to deserve their situation.
• Fear/Avoidance: The avoidance of movement and activity in an attempt to reduce pain. Studies show that this barrier generally results in both chronic pain and a disengagement from meaningful activities, which prolongs disability and may lead to depression.
• Disability Beliefs: Injured workers’ expectations about recovery and their ability to manage returning to work. Studies show that an individual’s perceptions of the impact of their condition can have more influence on lost time, levels of impairment and activity levels than actual physical or medical indicators.

HBAI covers one health and behavioral assessment and up to six hours of intervention sessions per 12-month period. A number of licensed health professionals may provide the treatment, including physicians, chiropractors, psychologists, social workers and counselors.

For more information, click here.