Technology, Telehealth Services Mean Faster CBT and Quicker RTWs

Technology has truly revolutionized the way medical care is delivered to injured workers. We can now reach them in a variety of ways not possible a decade or two ago. We’ve seen the positive results of treating injured workers as soon as possible with our recent program at Safeway Albertsons.

During the Self Insured Institute of America’s recent annual conference, I participated in a panel discussion about the changes the industry has adopted to ensure injured workers get the treatment they need as soon as possible and the significantly better outcomes we are now seeing. It is encouraging to see companies focusing first and foremost on the needs of the injured worker.

Earlier Treatment

We know that early intervention is key to helping injured workers heal and return to work quickly and in preventing creeping catastrophic claims. This is especially true when psychosocial risk factors are present.

Cognitive behavioral therapy, one of the most effective methods to address these issues, can help just about any injured worker with delayed recovery get back to function. But the sooner the person gets treatment, the fewer CBT sessions needed and the better the outcome.

An injured worker with psychosocial factors who gets CBT within the first few months is generally much more engaged in the process and typically requires fewer than 9 sessions. But an injured worker who has been out of work for several years – especially if he is on an opioid regimen – will require an average of 14 sessions of CBT to return to function.

New Technologies

Getting these injured workers into CBT as soon as possible is now easier than it ever has been, thanks to technological advancements. Here are some of the ways we are using it and how it helps:

• Stay at work. Ideally, you want your workers on the job, but that has not been possible because injured workers have had to leave work to get medical care. Through telemedicine, we can now accommodate these workers while they are still on the job. Companies can establish private areas where the injured worker can go and engage in CBT sessions. While face-to-face meetings are important – especially initially, telemedicine allows for additional sessions while the person is at work.
• Remote workers. Telemedicine has been a huge advantage in helping workers who are far away from urban areas. By logging onto their computers, tablets or smartphones, they can now connect with psychologists trained in CBT. We also have apps available to help them do the “homework” that is an essential aspect of CBT.
• Motivationally challenged. Some injured workers who have been using opioids for a long period are not interested in participating in CBT or anything else that will disrupt their “new normal” experience. Even though they may not want to be on the medications indefinitely, the idea of not having them available and having to make changes in their lives is just too scary. Their brains have essentially been hijacked by the drugs and the lives they are leading. Persuading them to go see a psychologist is nearly impossible. With technology, we now have a process whereby the psychologist engages in several 20 – 30-minute phone sessions with the worker to discuss CBT and make him comfortable with the idea. This has been very effective with some of these injured workers.  
• Psychiatric visit. Finding a psychiatrist who specializes in workers’ compensation is difficult, as they are few and far between. An injured worker who needs to meet with one would typically have to drive a far distance. With telemedicine, we can now easily do this. The psychologist meets face-to-face with the injured worker, and the psychiatrist joins via computer or another device. We work with 50 such psychiatrists – one per state, so this is now easily done.
• Trauma. It is crucial for workers exposed to traumatic events to be “debriefed” ASAP; otherwise, the brain has a negative response and begins to form pathways focused on the trauma. Instead of waiting 5 to 7 days, or whatever the workers’ compensation waiting time is for the worker to see a specialist, we can meet via telemedicine with the worker and help him to deal appropriately with the traumatic experience right away.
• The Cope Zone. This is the telemedicine app we have developed for our injured workers. We can set up their smart phone, computer or tablet to access videos, reading materials and CBT-type games.  Based on their smart phone or tablet’s motion detection and video camera, our apps we set them up with can detect movement by the injured worker. It enables us to provide biofeedback, an important element of CBT for some injured workers. It helps them regulate their breathing, which regulates the heart rate and lessens their pain. The app can also determine the worker’s blood oxygen level. It assists injured workers doing their CBT homework.
• Sleep App. Sleep is important in recovery for injured workers with chronic pain. CBT for sleep is very effective, and we set up patients with  an app that monitors their sleep. It has a microphone and includes motion detection, so we can gain insight into the worker’s sleeping patterns and give him feedback. The worker puts the smartphone under his pillow and turns on the app. One of the ways it helps, for example, is by making sure the person is not awakened during their REM sleep cycle. Assuming the person does not need to be awakened at a specific time, the app can detect when the person is in an REM cycle and delay the alarm until the cycle is finished.

Conclusion

The sooner we get medical treatment to injured workers the sooner they recover and get back to work. Through new technologies and on-demand services, we are making that happen – and seeing better outcomes!

Ascellus – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. Ascellus makes intervention efficient with a national network of 1,500+ psychologists and psychiatrists in all 50 states.