As the workers’ comp industry better understands the relationship between mental and physical health, a new generation of industry executives are leading the way to better biopsychosocial treatment.
Much of the discussion around coverage of PTSD by worker’s compensation has centered on first responders, and more state workers’ comp bureaus are recognizing PTSD as a compensable injury among this population.
While that’s a step in the right direction, the prevalence of PTSD among injured workers in other occupations remains underestimated. Anyone who has suffered a life-changing catastrophic injury or witnessed a violent event can experience the symptoms of PTSD.
The impact of PTSD on physical health outcomes likewise remains underappreciated. That prevents injured workers from receiving the multidisciplinary care they need to fully recover. A lack of understanding around how best to treat PTSD persists in workers’ comp.
However, the industry is waking up to the importance of taking a more holistic approach to treating injured workers — one that considers physical, mental and social factors together. That shift is driven by the entrance of new leaders who have a 360-degree perspective on the barriers that exist in healthcare and workers’ comp — and want to tackle them head-on.
One of those new leaders, Alana Letourneau, is not your typical MD. In addition to a medical degree, she also earned an MBA from NYU and a neuroscience degree from Princeton. Her experience includes conducting research on neuroplasticity, traumatic brain injury and PTSD, as well as working with data analytics and health technology.
As Vice President of Clinical Strategy for Carisk, Letourneau has found a way to pull all of this together to make a difference in the lives of injured workers.
“I’ve always noticed a number of barriers within our healthcare system that exist around the psychosocial aspects of recovery. For the most part, the connection between mental and physical health is simply not addressed in patient care, especially in workers’ comp,” she said.
Letourneau has worked to break down those barriers by demonstrating the impact of PTSD on medical outcomes and building a model to capture mental health factors that too often slip through the cracks.
New Insights Around PTSD and Physical Health
At NYU, Letourneau led a study examining the correlation between traumatic brain injury (TBI) and PTSD among 150 survivors of torture. Some of these participants had experienced either a TBI alone or PTSD alone, while others experienced both.
“There’s a common cluster of physical symptoms following traumatic brain injury known as postconcussion syndrome, which can include headache, dizziness, ringing in the ears and difficulty sleeping,” Letourneau said. The severity of these symptoms, in conjunction with PTSD criteria established by the Harvard Trauma Questionnaire, were used to create a physical health score for each patient.
Those scores —representative of overall health outcomes — were subsequently tracked over a four-year span. The results highlight how tightly PTSD is bound to physical health.
“We discovered that individuals with more severe PTSD scores experienced worse physical health. Those patients who only had traumatic brain injury but did not have PTSD had fewer physical symptoms than patients who had both traumatic brain injury and PTSD,” Letourneau said.
“In other words, PTSD was driving the severe physical health symptoms, not just the head injury. Addressing psychological health, therefore, can really improve physical function.”
Within the realm of workers’ comp, other studies have shown how PTSD contributes to poor outcomes. Claimants with PTSD have more medical visits and higher rates of absenteeism over the long term, and therefore are more likely to become unemployed. This occurs independent of any other physical injury involved.
“In general, research has shown improved health outcomes in injured workers who participate in a biopsychosocial model of care. Those improved outcomes include reduction of pain, reduction of mental health symptom severity, as well as a reduction in the time it takes to return to work,” Letourneau said.
Barriers to Care in Workers’ Comp
Workers’ comp payers and the healthcare system in general are increasingly recognizing the importance of addressing psychological, emotion and social factors in order to achieve optimal medical outcomes. But that hasn’t translated into a consistent, evidence-based approach to care.
Potentially the biggest barrier to treating PTSD in workers’ comp is the determination of compensability. Every state seems to treat PTSD differently; some recognize it as a compensable injury among first responders only; others require an underlying physical injury that gives rise to PTSD; still others address the issue on a case by case basis, placing the burden of proof on claimants to show that the conditions that caused their PTSD are outside the normal conditions of their employment.
Payers often hesitate to delve into mental health conditions because unlike physical injuries, their cause is not always cut-and-dry.
“In our referred cases, we find we have the most success by proposing multi-disciplinary, integrated solutions. Not surprisingly, research has shown significant co-occurrence of mental health conditions, including PTSD, in chronic pain cases. Other research has demonstrated that psychosocial factors are the number one barrier in cases of delayed recovery. Since the relationship between mental health and physical health conditions is bidirectional, determining the direction of causality can be indistinct. Therefore, it’s important to address both aspects equally,” Letourneau said.
A Biopsychosocial Model Bringing Integrated Care to Injured Workers
Along with Carisk’s Vice President of Clinical Services David Vittoria, Letourneau helped to develop a biopsychosocial model that identifies mental health and social risk factors and connects patients to the appropriate services and providers.
“We conduct a biopsychosocial assessment that covers the patient’s medical, psychological and social needs. We’ll also speak with their current providers and their social support system, whether that’s friends or family members or another caretaker,” Letourneau said. “Through that assessment, we’re looking to identify potential barriers, risks, interventions, as well as expected outcomes on the case.”
That information is synthesized into a detailed recommendation for the treatment and services required for this patient and delivered to the payer in the form of a Care Coordination plan. The Carisk team’s research and direct clinical experience with trauma and PTSD patients enables them to make sound, scientifically-backed recommendations that payers can trust.
“Having that in-house expertise is critical. We know what types of therapy would be most appropriate for this individual and we can direct them to the right specialists. We often will match the therapist with the patient based on the therapist’s level of experience, treatment modality, location, and other characteristics,” Letourneau said.
For example, a recent female patient with PTSD was specifically matched to a female therapist because of her prior history as a victim of abuse. “Having a female trauma counselor was really important to this patient,” Letourneau said.
“At Carisk we truly approach the patient from an integrated care perspective. As a managed behavioral healthcare organization, we’re positioned to connect all the right providers and services to address the psychological and social factors underlying an injury.”
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Carisk Partners. The editorial staff of Risk & Insurance had no role in its preparation.