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Julia Bunn video

Rehabilitation and return to work plans for psychological injuries.

RUN TIME: 1 hour 3 mins 7 secs

Hi everyone. I'm Todd and I'll be your MC for today. Welcome to the fifth Online Work Well 365 Speaker Series session for 2022. I would like to begin by respectfully acknowledging the traditional custodians of the land we are speaking to you from today and on which you are learning and working from today. We also pay our respects to elders past and present and extend that respect to Aboriginal and Torres Strait Islander people watching today. In this session, you'll hear from occupational therapist Julia Bunn. Julia has over 25 years’ experience specializing in the field of vocational rehabilitation and a passion for assisting workers achieved successful workplace rehabilitation outcomes. In 2005, Julia established her own rehabilitation company where she works with a team of like-minded allied health professionals who share her vision of enabling better lives by maximising the health and wellbeing of individuals and organisations. Julia is also an active founding member of the Australian Rehabilitation Providers Association and committed to ongoing industry development in the field of occupational rehabilitation.

In her presentation, Julia will discuss primary and secondary psychological injuries and the health benefits of good work super friends taking action best practice framework for the management of psychological claims and why early intervention and support is crucial for psychological injuries and how to capture this in an RRTW plan. Julia will also look at the roles of various stakeholders who should be involved in RRTW planning, including the injured worker, the insurer, the employer, rehabilitation and return to work coordinator, supporting recovery at work and treating health providers. There will also be the opportunity to ask Julia questions at the end of this session, so please be sure to submit them in the chat box. Welcome, Julia.

Hello. Thanks, Todd. As Todd said, my name's Julia Bunn and today I've been asked to speak about rehab and return to work plans for psychological injuries. I'm an OT and I've been working in the field of workplace rehab for over 25 years, but today I'm presenting in my role as the Queensland Chair of ARPA, which is the Australian Rehab Providers Association, as well as referring to what's considered best practice management of psychological injuries. I'll lean heavily on what it's like operating in the Queensland Workers' Compensation system, particularly the draft rehab and return to work plan guidelines for insurers, which is in the development phase with the worker's compensation regulatory services at the Office of Industrial Relations Queensland. Any of us who work in the field of workplace injuries will be aware that prevention and management of psychological injuries is currently the focus for our regulators and insurers, employers, health providers, and the community as a whole. Some recent stats out of the New South Wales workers' comp scheme really demonstrate the changing nature of workplace injuries. As of today, around 11% of all active workers' comp claims relate to a psychological injury compared with 6% a decade ago.

People who have a psychological injury are less likely to return to work and more likely to experience an adversarial claims journey. People with a physical claim lose on average six weeks of work for psychological claims, the average time lost is 20 weeks and alarmingly, people who access psychological services after a physical injury are off work for more than 31 weeks. So, the group who experienced the worst outcomes are those with physical injury and a secondary psychological injury. Now, these stats have an impact on all stakeholders. Today, I'm aware I'm presenting to individuals who belong to each of those stakeholder groups, particularly Queensland rehab and return to work coordinators, um, who represent a variety of employers as well as insurers workers and medical and rehab providers is I hope to deliver you some practical strategies to assist with the management of psychological injuries. Regardless of your role, we'll look at the best practice ideas as well as a case study to demonstrate implementation of those best practice methods. Although our roles differ, differ, we're all in this together. We all have a role to place to play in managing psychological illness for our workers, so please keep your questions till the end and I'll be happy to answer them then.

So, as well as drawing from my own experience of working, uh, in the workplace rehab field, I've drawn on a number of relatively recently published publications about the principles of best practice management for psychological injury. These come from the Super Friend article by Work Safe Australia in 2018, and the AFOEM papers on “It pays to care”, which were released this year. There is still work to do to develop an evidence-based best practice model of, So firstly, I want to make a distinction between treatment and rehab. Treatment is the effort to improve the health outcomes of a worker by healthcare providers, whereas rehabilitation seeks to minimise impairment and disability and improve social and vocational outcomes. Now, much of the literature on mental health is focused on clinical treatment and health outcomes, but there is much less evidence on vocational rehab and work outcomes. What we do know is that clinical improvement and medical improvement doesn't necessarily improve work participation or productivity, and there's a really poor correlation between the severity of symptoms and work capacity. There is, however, acknowledgement that people with psychological injuries require additional help over and above the treatment of their symptoms. They need help to return to work.

So, let's have a look at what these principles for best practice of managing psychological injury claims might look like. I've tried to simplify the approach by creating mnemonic using the word REACH. I really like the visual concept that comes with the word reach. We reach out to each other, um, we connect with each other, and these are some of the key principles, um, of managing psychological claims. So, let's have a look at what these letters stand for. Number one is for the right services at the right time, and we deliver this through a bio psychosocial approach. Number two is early intervention. Number three is expectations about recovery. They need to be addressed. Number four is having the employer engaged with the worker. Number five is collaboration. And finally, the sixth. The H in our REACH scenario is human centered or client centered. So, let's take a look at each one of these in more detail. Firstly, the right support at the right time. This should be bio psychosocial, and work focused. So, ensuring the worker receives the right support at the right time is imperative. This is achieved through a bio psychosocial approach. Now, there's loads of evidence supporting the use of an integrated bio psychosocial screening and then matching the right interventions at the right time.

A biopsychosocial assessment is used to understand the worker's injury or illness, which is the bio, and then their context or their environment, which is the psychosocial. This enables us to identify barriers and put in place appropriate, appropriate supports to achieve the desired outcomes. These supports include treatment and rehabilitation, which are tailored to the worker and to their environment. We then periodically review the workers bio psychosocial status so that treatment care and rehabilitation can be adjusted to match the identified needs at the right time. This has been shown to achieve the best outcomes we've known over the last two de decades that a biopsychosocial screening should be undertaken for all workplace injuries. The OMPQ or a REBO assessment is now well recognised as a valid tool for the early identification of bio psychosocial risks. Although it was developed for musculoskeletal pain conditions, it's still a really useful simple screening tool for all conditions. Unfortunately, though the consistent implementation of simple bio psycho bio psychosocial screening tools is still really patchy. Now, the management of the bio or the medical is predominantly in the hands of the treatment providers. However, there is evidence that cognitive behavioural treatments that are work focused are the most effective. So, this should be encouraged in our treatment providers.

Then, as case managers, we are required to focus on the psychosocial factors, particularly work. There is strong evidence that interventions for psychological claims that add most value are focused on work and are holistic. So, what this means for us as rehab managers is that the intervention should be workplace based. They need to have clear goals and rehabilitation strategy, and they should be subjected to a review and evaluation cycle, and they need to go above and beyond your legislation requirements. They should support transition into new employment. The second key principle is early intervention. This shouldn't be a surprise to any of you. The evidence clearly highlights that for all injury claims, early screening and intervention is essential. This means a focus on the early access to treatment and rehab programs rather than eligibility decisions. It means the screening for psychosocial factors as soon as practical. The worker should be screened for risk factors regardless of their injury type to minimise the risk of secondary psychological injury, it means that screening must be combined with providing the worker tailored interventions and additional support. It means that the therapeutic window for treatment is in the six to 12 weeks from the first day of work. That's the first sick day. So, injury needs to be reported or notified early in that onset window. This requires supervisors who are able to identify the early signs and symptoms of psychological ill health and to escalate this appropriately. So, we've learned that mental health first aid training can really assist to build capability within an employer group where possible. Early intervention also means that a worker should be able to access appropriate treatment as soon as possible.

So, to achieve this as employers, we need information and guidance from the insurers as well. This should include a claim determination process that's clear, streamlined, and well communicated. A dispute resolution system that's timely, uncomplicated, and transparent so that it minimises anxiety for the worker. And finally, a system that encourages ongoing engagement between the worker and the employer. Early intervention is also about early treatment, and so I'd like to make comment on provisional liability. The Queensland Workers' Compensation system now provides provisional liability for psychological injuries, which allows worker to access psychological treatment while their claim is still being determined. This certainly improves that early access to treatment for our workers, but we must also be mindful that work focused services are also integrated, uh, also integral at this early stage of a worker's injury. The third key point is about expectations about recovery. We know that a worker's expectations about their recovery have a really strong predictive value of their actual outcome. In the early stages of a claim, the worker's expectations about recovery and return to work are malleable. So, an optimistic outlook should be actively cultivated as part of any contact with the worker, the employer, health professionals and claims managers.

The evidence shows that if health professionals address low expectations of recovery early in the course of the illness, that this can reduce the likelihood of a condition becoming chronic. There should be a focus on the worker's ability rather than their disability or their symptoms. We need to focus on the experience of the worker, particularly in those early stages of the claim. So, watch out for your forms and paperwork. Look for technically ambiguous communication. Avoid repeated questions on the same information as all of these can be perceived by the worker as questioning their honesty and their eligibility being questioned. A worker experience of trust and immediate support is also paramount. The fourth key concept is about an engaged employer. Employer engagement in the return to work process has shown to measurably improve outcomes. This includes timely support, um, and supportive contact from the employer following the initial injury or claim. It involves ensuring that the worker perceived that their work is valued. It involves management being committed to the return to work effort. So that means finding suitable duties and making reasonable work adjustments. It involves support from the peers and the supervisors in the return to work process. It involves proactively addressing any relationship breakdowns between the employer and the injured worker.

The fifth of the sixth concept on best practice for managing injuries is collaboration. Proactive, authentic collaboration with all key stakeholders is probably one of the central points of my presentation today. Communication and collaboration between stakeholders in the return to work process is imperative. This requires clear protocols and expectations for communication and understanding the roles of the various parties involved. We need to ensure that expectations and obligations are understood and aligned. Now, there is a mutual responsibility with the insurer and the employer for achieving a successful return to work. However, a clear distribution of responsibilities is imperative. The best practice framework presented by SafeWork Australia suggests that one person, either the insurer or the employer, depending on the legislation, one person needs to take responsibility to provide end to end case management and a single point of contact for the worker, for the employer, the insurer, the treating practitioners, and other service providers throughout the whole claims process here in Queensland, this is one of the areas in which I've always experienced some real conflict, who is responsible for the case management of a worker's comp claim? What we know for sure is that someone needs to take responsibility for the case management.

Our legislation in Queensland defines the roles and responsibilities of employers and insurers regarding this. It clearly puts the responsibility for the return to work plans in the hands of the insurer during the statutory claim. However, with our understanding of the continuum of a worker's experience with psychological injury, both before and after the period of a worker's compensation claim, we know that practically managing this responsibility is very difficult.

To this end, the worker's comp and regulatory services section in the Office of Industrial Relations in Queensland is in the process of providing further guidance to help clarify the role of the employer and the role of the insurer in managing psychological injuries. Under the Queensland Act, insurers and employers have distinct and separate responsibilities for supporting workers who sustain a work related injury. To return to timely, safe, and durable work, insurers must take all reasonable steps to coordinate the development and maintenance of a rehab and return to work plan. For workers who sustained an injury, that is the insurer's responsibility. Employers must be involved in the development of that plan and provide meaningful, suitable duties. Employers also have duties under workplace health and safety laws to ensure the work, ensure the health and safety of their workers is reasonably, um, provided. So, this reinforces the need for authentic collaboration between insurers and the employer to establish protocols for the transition of employers on either end of the statutory claim.

At a minimum, the insurer must ensure that the employer is actively involved in the return to work planning and interventions. So, these new guidelines currently in consultation phase, um, then encourage this. They also encourage insurers to undertake an assessment of the complexity of the case to ensure that case management and rehabilitation planning is carried out by suitably skilled and experienced case managers. And this is particularly the case for complex cases like individuals with psychological injuries in Queensland, WorkCover is able to refer out to workplace rehabilitation providers to develop and case management develop and case manage the rehab and return to work plan through their existing provider management framework.

And finally, onto the sixth principle of best practice management of psychological cases. And this is H for human-centered centered. This is also known as client-centered or a person-centered approach. This refers to a focus on the worker as an active contributor and collaborator on their own return to work plan. It incorporates empowering the worker to take ownership of their rehab goals and activities. In this model, communication is positive and supporting individual circumstances, including the nature of the psychological injury, their social environment, um, and other issues are taken into account throughout the process. Usually targeted mental health literacy education is provided to the worker to assist them to understand their needs and to set realistic goals. An approach means allowing an individual's worker's, values, beliefs, circumstances, and needs to guide how services and supports are designed and how and when they're delivered. And enabling a worker to participate meaningfully in the decisions that impact upon them in partnership with their support team, the insurer, the employer, and the treatment providers. I think this is like having a return to work pro return to work plan that is developed with the worker rather than being done to the worker.

Some practical ways that we can apply this human centered approach in our practice include planning with the worker and providing opportunities for them to suggest actions and solutions. It can involve supporting the worker to help set the goals. It involves inviting the worker's input on barriers and enablers for their recovery and their return to work and doing things in a way that works best for the worker as well as focusing on their strengths. So that brings me to the end of those best practice principles and that mnemonic to remember to reach out so the right services at the right time through a bio psychosocial approach. Early intervention expectations about recovery are addressed. Employer is engaged with the worker collaborative approach and a human-centered approach.

Let's talk a little bit about secondary psychological injury. The principles for best practice case management whilst focused on psychological injury are just as relevant for all injuries and are also appropriate for the management of secondary psychological injuries. As we heard in my introduction, the group who experienced the worst outcomes are those with a physical injury and a secondary psychological injury. So, in addition to the forementioned best practice principles, some additional measures can be undertaken to minimise the risk of secondary psychological injuries and to provide early support to the worker when those injuries do happen. So, some of these things can involve using analytics to assess which physical injuries or illnesses are likely to escalate into secondary psychological claims. Secondly, reviewing our claims processes to minimise delays and stress and uncertainty for the worker. And finally, by managing some high risk physical injuries as though they were potential psychological injuries right from the start.

Workers who report positive interaction with their case managers have been shown to have higher rates of return to work. They report less pain, have greater perceived ill health, greater perceived health. They're quicker to recover and have improved quality of life. It's therefore essential that whoever is responsible for management of a worker is adequately skilled. Now, best practice case management is more than simply a matter of processing paperwork or processing payments. Safe Work Australia goes as far as defining the skills and experience required to case manage complex and psychological cases. And here they are. There's a really long list. The case manager needs to be proactive. They need to be able to seek expert evidence-based advice, um, that they require, and then to make the decisions on injury management, treatment and rehabilitation, the case manager needs to be competent in communication and negotiation strategies, setting expectations, empowering the worker, educating and influencing stakeholders involved in the claim and implementing sound decisions to influence recovery at work and return to work outcomes.

This is a pretty big ask. This is a really big ask for all of us, but for insurers who are also undertaking claims determination and management functions, and also for return to work coordinators, especially if the return to work coordinator role is one of many responsibilities that you carry out. And if complex or psychological injuries are not a regular occurrence at your workplace, it's fair to say that with the skills shortage faced in most industries at present, we all have some work to do to build capability for effective case management of our injured workers. The use of external workplace rehab providers can assist to fill gap. Workplace rehab providers brings specialist expertise in the assessment and case management of complex psychological claims. In Queensland, workplace rehab providers work under a provider management framework that has been developed by WorkCover Queensland. This is managed by WorkCover through its contractual panel arrangement for return to work providers and through the return to worktable of costs. So, I'd now like to demonstrate how we implement these best practice principles within the Queensland legislation and guidelines through the use of a case study. Now, this case study on Sally Chalk is completely fictional, but it is based on a number of case studies, which was submitted by our member organisations in Queensland for the APA Excellence in Workplace Rehab Awards over the last few years. I hope there are elements here that are familiar to many of you. So, let's meet Sally.

Sally is a 39 year old female. She's a primary school teacher at Gumtree Primary School with 18 years of classroom teaching experience. She's been at Gumtree Primary for eight years since returning to work, following having her own two children. She job chair, job shares, teaching the class of year 3M with a co-teacher narrator. So, Sally works three days a week, Monday to Wednesday, and narrator works two days a week on the Thursday and Friday. Now, Sally experienced bullying from a parent in 3M over a gradually increasing frequency during term one and two this year. And this culminated in a major event at a parent teacher interview on the 2nd of May. This bullying or occupational violence has led to the onset of severe anxiety and PTSD symptoms for Sally. Sally has tried to manage her symptoms on her own. She saw her GP who prescribed anti-anxiety medication, and she also utilised the confidential EAP counselling services offered by her sch offered by her school. Um, but she's used up 12 sick days of leave over May and June this year before finally lodging a workers' comp claim in mid-June on the 17th of June. Now, upon receipt of that claim, Robert, the case manager at WorkCover liaised with Sally and liaised with Nicole the rehab and return to work coordinator at Gumtree Primary.

A screening of Sally's case identified that it was complex due to the time since Sally's symptoms had commenced and due to the psychological symptoms she demonstrated and her diagnosis. So, in the interests of best practice case manager, the claims manager at WorkCover referred to a workplace rehab provider on their panel to develop a return to work plan. So, the rehab provider, Julia, commenced a bio psychosocial assessment.

This involved a review of the work capacity certificate, an initial phone conversation with Sally, the worker, and Nicole, the rehab and return to work coordinator, and Robert the WorkCover claims manager. She focused on providing support to Sally, and she developed a rapport with her. She explained her role to all of the stakeholders so that the roles and responsibility and expected processes were clear from them all. The next step was a face-to-face interview with Sally. He, she completed a more thorough biopsychosocial assessment with a variety of tools to help her understand Sally, her symptoms, the aspects of her psychology and motivation end her social situation better with Sally's authority. She undertook a teleconference with Sally's treating psychologist to get a better idea about the status of her treatment, and to get further detailed advice about Sally's readiness to return to work with Sally's authority, she undertook a teleconference with Nicole, the rehab and return to work coordinator to get a better understanding of Sally's specific duties, the organisational structures at the school, and the their commitment and ability to provide a supported graduated return to work program.

As a result of this assessment process, Julia found out the following significant information which was relevant to the development of a rehab and return to work plan. So, these are some of the things that happened over the next couple of weeks. So, Sally was referred to a psychiatrist who has confirmed the diagnosis of PTSD. The psychological counselling has been focusing on managing techniques, sorry, management techniques for her panic attacks and for intrusive thoughts and nightmares that are related to the bullying incident. These, these thoughts are triggered by Sally's thoughts of that classroom where the 3B class sits. Sally feels really embarrassed by her response to the bullying because her co-worker narrator also experienced the same behaviours from that parent, but she wasn't affected in the same way. Sally feels soft and as though she's let narrator down and let her pupils down by taking time off work. Sally really is not confident about her ability to return to classroom teaching. She feels supported by Nicole, her rehab and return to work co coordinator, but is really concerned about the stigma associated with her situation and, and she's concerned that the school admin staff in the office and possibly some of the parent body are aware of her situation as well.

Nicole, the rehab coordinator, confirmed that this is not the case now. Sally's husband and family are supportive of her taking time off and financially they are able to cope until the WorkCover claim is determined. WorkCover are funding the psychological counselling and the medical treatment through their provisional liability scheme, and they've indicated that they are processing Sally's claim as quickly as possible. Um, and we find out that the claim is subsequently accepted. Sally will be unfit for work for about five weeks up until the beginning of August when a gradual return to work may be able to commence. Sally currently feels overwhelmed by the prospect of returning to three B. She doesn't think she could face the daily rigors of being a teacher at present. Sally's own daily routine is topsy-turvy. She isn't sleeping well and there, and she isn't coping even with maintaining her own children's school routines. Liaison with Sally. The return to work, uh, coordinator identified that Sally is a really well respected teacher on staff, but they just don't know what else they can do to support her. There's already difficulty for finding relief teachers at the moment, and so Nicole has really welcomed the support from Julia as she's under-resourced in her role as rehab and return to work coordinator.

So, this bio psychosocial assessment took place over about two weeks in the second half of June. Julia then discussed a potential rehab and return to work plan with Sally, which would step out what actions could be undertaken over a three month period to get a return to work underway. Julia explains that like all plans, they can be adjusted along the way to meet Sally's needs, and that a review cycle would be undertaken to ensure that the rehab and return to work plan was realistic and supported, and that it reflected Sally's situation. So, Sally agreed to give it a go, and she requested that this gradual step by step approach would be best.

So, let's have a review of what a rehab and return to work plan looks like under the draft WCR s guidelines for insurers. So, the draft guidelines say that in Section 220 of the Act a Rehab and Return to Work plan is a written plan, like the example I've got here, that it outlines the rehab objectives for the injured worker and the steps required to achieve those objectives. That it's developed in consultation with the worker, the employer, and the registered persons treating the worker. That the plan is a tool for insurers to coordinate effective planning, management, and review of a worker's rehab and return to work, and to promote collaboration and communicate, and to coordinate communication between all of the stakeholders involved in facilitating rehab and return to work. A person-centered approach recognises that the format of the rehab and return to work plan may vary for each individual worker. So, this is just one example I'm presenting today, but it can vary depending on the complexity of their injury and the individual rehab needs. So, this is a sample rehab and return to work plan, which I've taken straight out of the WCR s draft guidelines. It can be tailored to suit your specific needs.

So, you can see on this first page, it includes information about who all the key stakeholders are and some information about the injury when it occurred, how it occurred, what the medical restrictions are, and the functional capabilities. It then starts to talk about the worker's job and their location

On the second day page of the rehab and return to work plan. We can see that the goals are set for the plan. So, through discussion with Sally, she agreed that she wanted to return to her same job with her same employer. The plans duration is over a three month period from the 1st of July to the 30th of September, but it will be reviewed on the 1st of August. The expected recovery timeframe based on all of that by a psychosocial assessment undertaken, is that during July, Sally will undergo psychological counselling and treatment, will identify some suitable duties and start to develop a suitable duties plan and review that at the end of July. And then through August and September, we will then commence and upgrade the suitable duties plan. You can see at the bottom of page two there, it lists the objectives that are going to be completed as part of the plan, the strategies and actions that will be undertaken to achieve those objectives, who's responsible for participating in those actions and the timeframes in which they should be completed. And that's carried on over to the third page of the Return to work plan, which moves beyond pre liability treatment and participation in clinical treatment through to planning of the return to work and the development of a suitable duties program.

You'll notice that in planning the return to work, some of the activities involve getting guidance from the GP and psychologist undertaking a case conference with the psychologist to really work out the details of the return to work plan, or, sorry, the suitable duties plan, and to maintain that contact and collaboration with the workplace. The development of the suitable duties plan will involve a workplace assessment and liaison with the worker to investigate what duties might be available. There'll be group meetings at the workplace to set that up and coordinate it. And then at the end of the return to work plan, there needs to be opportunity to show that all stakeholders have been involved in the development of the plan, and they acknowledge the plan and understand it. So, this can be achieved by obtaining signatures or demonstrating that you've, um, performed consultation at the end of the plan. In this example for good practice, it also, um, summarises the roles and responsibilities of each of the stakeholders. So that's the example of the rehab and return to work plan. So, one month on, we can look at some of the complex elements of this case and how they were managed.

So, at that time, the review showed that the medication and psychological treatment was resulting in improvement in Sally's symptoms. Her home routines and coping skills were better. However, the psychologist has recommended that Sally should not return to that same physical classroom environment as the bullying incidents took place because that environment was a trigger for her panic attacks. Sally, by this stage, was really open to exploring a return to work in some capacity, but her confidence was really low, and she still feels stigma associated with her situation, and also due to her fa due to her failed attempt to stay at work. Uh, prior to taking time off

The workplace rehab provider, Julia undertook a work site assessment with Nicole, the rehab and Return to Work coordinator. And there was a bit of a surprise at this one. At this meeting, it was an identified that narrator, Sally's co-teacher wasn't supportive of having Sally returning back to their class at Class three B because it had already been so disruptive in the classroom. She felt that bringing Sally back, especially if she wasn't really ready to return to work, would be too disruptive to the students. And she also thought that the parents who were responsible for that initial bullying hadn't really changed their ways. So therefore, the goal to return Sally to, to her pre-injury position needed to be rethought, needed to be adjusted. Nicole, the rehab and return to work coordinator did confirm that a graduated return to work could be undertaken in another class somewhere else in the school.

So, they went away. And further research was undertaken by Nicole regarding the suitable duties. She found that one of the year four teachers was taking long service leave later that year, and that the principal was currently looking for a relief teacher to take on his class for the remainder of the year. So, these findings were shared and discussed with Sally, and together a suitable Judy's plan was developed. This was a stepped process to allow Sally to start work as a supernumerary teacher in the year four classroom for two weeks before commencing an independent teaching role on her own. The workplace rehab provider, Julia, uh, also provided education to Nicole, the workplace rehab coordinator about the practical steps that she could undertake to support Sally. Uh, this included knowing what questions to ask Sally and Sally and how to respond to those findings, how regular that communication could, should be, and how to maintain privacy in the busy school environment. Um, this enabled Sally to move past her concerns about the stigma of her injury and really strengthen the relationship with her employer. So, here's an example of the suitable Judy's plan. Again, it's a separate document from the rehab and return to work plan. This is the one that's developed at the workplace that the employer is responsible for, for developing and participating in. So, we can see that it sets out a week by week stepped approach just for three weeks. It defines the days and hours that Sally will be working, the duties she'll be performing, and the restrictions.

It shows what counselling and treat, or treatment will be continuing. And on the second page, it allows for sign off by the key stakeholders to demonstrate that everyone's been consulted in the plan, and they fully understand the way forward.

So, it's at this point that we'll leave our case about Sally. I think it's really demonstrated for you how best practice principles can be implemented, and we've looked at the practical implement implementation of the insurer guidelines for the development of rehab and return to work plans for psychological injuries. If we follow these best practice principles, then we stand the best chance of reaching the best outcome for our injured workers. Psychological injury claims present unique challenges. Best practice claims management begins with understanding that these cases are complex and by reaching out to the injured worker to ensure they feel empowered and supported throughout the claims process. Finally, I just want to have a quick word about workplace rehab providers. Today we've looked at how workplace rehab providers can assist you in early intervention and in the return to work phase of a worker's injury. But in addition, workplace rehab providers can work more broadly with your organisations to assist in managing worker health and wellbeing throughout the life cycle of your employees. This includes through pre-employment, through injury prevention, and through maintaining a well workforce. We are experts in healthy workers and in healthy workplaces.

APRA, the Australian Rehab Providers Association is the peak body representing the workplace rehab industry in Australia. And our members and the, and the members, um, and workplace rehab consultants that we employ are committed to facilitating the personal, social, occupational and economic independence of individuals within with injuries and with disabilities. So, I hope I've managed to enlighten you somewhat today about the benefits of using a workplace rehab provider to assist in the case management of psychological injuries. And for further information, or to find out who the APA members are in Queensland, I'd encourage you to please visit our I'll hand back to you. Thanks, Todd.

Thanks, Julia. Now we have some questions from the audience today. So, question one has come from Sue. So how do you combat a resistive employee who does not respond to your calls, emails, or text messages to support also the lack of communication from the nominated treating doctor as well?

Okay, that's a big question. So firstly, um, let's deal with the doctor and the employee separately. So, look, not responding, um, is not uncommon for injured workers with psychological illness. This can act actually often be one of the symptoms of psychological illness. So, um, again, it really highlights the importance of working as best you can to develop, uh, a relationship with the worker to develop a rapport, um, and to understand perhaps why they feel reluctant to engage with you. Um, often that's when it's a trigger to bring in an independent provider, an independent specialist, to assist with the development of a rehab and return to work plan, uh, particularly someone with an allied health background who's able to understand, um, you know, best how to engage with the worker and with their treating providers. Um, the second part of that point about, um, how do we liaise with doctors perhaps who won't liaise with us.

Look, I know that that's a common one, particularly for rehab and return to work coordinators. Um, there's, there's, um, issues around being as efficient as possible to work in with the doctors, um, communication systems. So, emails and faxes, um, are still the, the order of the day in liaising with doctors. Um, but certainly as rehab providers, we are also really adept at undertaking case conferences where we would go and sit in the doctor surgery with the worker. Um, specifically for per, um, discussing return to work services. Um, this is done within privacy guidelines and with the workers' authority, um, and it can be paid for through a worker's compensation claim. So that's sort of the best way to get through those barriers. And we would, um, always refer back to, um, the A O E M guidelines for the health Benefits of good work, which are written by doctors and really useful for educating doctors.

Thanks, Julia. A question from David where he says, just like physical injuries, I found it difficult with a lot of doctors to get them to see that there's a lot of suitable duties possible. How do we educate more doctors on the role of return the work and the ability of suitable duties?

Yeah, look, that's a tricky one. Some larger organisations are lucky enough to be able to have preferred doctors who can attend their workplace and develop a really good understanding of the variety of tasks available and the willingness for the workplace to provide, you know, alternative duties and suitable duties. Um, aside from that, the other thing we can do is develop job dictionaries or, um, task analysis of the different jobs available within our workplace and provide this to the doctors to demonstrate we've, you know, we've analysed what we've got available and how do we find a match between these alternative duties and what the restrictions or the needs of the worker are. Um, so providing that tool directly to them, and again, potentially through a case conference scenario, is the best way to get that information through to the GPs.

Thank you. So, question three has come from Fiona. Can employers refer to workplace rehab providers prior to a claim being determined?

Uh, yeah. The simple answer is yes. We love to work directly with employers, you know, a really seamless approach, um, to assist you with early intervention, um, even before a claim takes place, we'd love for claims never to happen. Uh, what that means though is that, uh, if you're employing a workplace rehab provider outside of the WorkCover referral, then as the employer, you'd be responsible for the costs, um, particularly if the claim is subsequently not accepted.

Thank you. So, Chris has asked, what happens when you can't get everyone involved in a return to work plan that needs to, how do you ensure you have a suitable rehabilitation and return to work plan?

Look, I think, uh, the key group that tends not to get involved is probably the, the employer. And that can be for a variety of reasons. It's usually to do res with resources at the workplace. So, they just may not have suitable duties or they're too small or, you know, don't have the ability to offer, um, actual suitable duties in their workplace. Uh, in this case, it's, um, it's, we're able to work with the insurer to look at host employment situations. Um, so we find a host employer who can offer suitable duties, um, and then the rehab provider would be involved in that workplace assessment, um, engaging and educating with the host employer as well as the injured worker, uh, to develop the duties that are suitable. And of course, that involves liaising with treating providers to ensure sign off on those duties. So, the, the host employment scenario can be used both to, uh, increase, um, work capacity, um, and then return back to your normal job or host employment leading potentially to a new permanent job down the track.

Okay. So, question five comes from Patrick, psychological injury claims take a lot longer to be accepted or rejected than a physical injury. This period of limbo can result in additional stress to the worker. So, what rights does a worker have to access treatment while they're waiting on a decision about their claim?

Yeah, look, I absolutely agree. We've talked about early intervention. We've, you know, we know that, um, getting in early and getting treatment is one of the key areas to get a better outcome. So, the Queensland Workers' Compensation System now offers provisional liability, which provides access to psychological treatment for anyone who's made a claim for psychological illness. So, you're able to get that early access to treatment whilst waiting for the claim to be determined. That's a, a game changer in Queensland, and, um, you know, it's, it's easily accessible for workers.

And question six, uh, thanks to Tina. If an employer believes that an employee might be exhibiting a secondary psychological injury, how do we broach this?

Look, it is what it is. I remember, you know, for a long time we used to kind of shy away from naming sec secondary psychological injuries, but they're a real thing. Um, they certainly affect the outcome. And so, um, a biopsychosocial approach, whether it's applied on a physical case, which has potential for, um, secondary injuries or just on, on psychological injuries alone, applying that biopsychosocial approach enables you to address those psychosocial factors early. So, we identify them early, and by doing that continuous review and checking cycle, we check in as the case progresses, um, to identify the onset of those early, um, psychological signs and symptoms. Uh, I think generally our workers, um, understanding of mental health and wellness also now equips us with the opportunity to have better discussions about mental health and wellbeing and to undertake some early intervention techniques. So, things like adjustment counselling or any counselling services, you know, are, are more the norm these days, particularly coming out of Covid. So, um, you know, I think keeping with that bio psychosocial approach is the, the best way to keep an eye on potential psychosocial illness developing.

Thank you. And our final question is very relevant to today, and the, and the, the world we live in is, Fiona was just wondering, can telehealth be used to replace face to face treatment or workplace rehabilitation?

Uh, look, telehealth can be used effectively, and of course we had to, uh, move to a lot of telehealth, uh, treatment services during the pandemic. I think the jury's still out as to whether it's as good as face to face, but it's certainly recognised to be a really valid adjunct to face to face treatment services. Um, the reality is that, you know, it's difficult to get in to see psychologists and psychiatrists face to face all the time. And so, I would certainly expect to see, um, some telehealth services replace those face to face services, but probably not a hundred percent replacement of the services. Um, as for workplace rehab, look, nothing beats face to face and getting into, um, the workplace to really assess what's going on, um, to meet with the workers and identify, you know, the barriers to return to work. However, again, it's not always possible. And certainly, most of us rehab providers, you know, we've done work site assessments remotely using workers', you know, holding iPhones and, uh, assessing ergonomics, et cetera from afar. So, it's able to be done. It just doesn't fully replace the face-to-face services.

Well, thanks to everyone for joining us today. We hope you're able to take Julia's information and implement it in your workplace. Today's presentation recording will be available on our website. Keep an eye out for it in the coming weeks. We'd also love to get your feedback on today's session. So please click on the QR code now to complete our short survey. We'll also be emailing the link out to everyone if you don't get a chance to complete the survey now. Also, check out the work website for other events and a full range of industry and topic specific video case studies, podcasts, speaker recordings, webinars, and films available to help you take action to improve your W H S and return to work outcomes. These resources are free to download and share, so I encourage you to share them with your staff and networks. Have a great day, everyone, and remember. Work safe. Home safe.