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Behavioral Health Disability and Occupational Medicine: Practices

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Handbook of Behavioral Health Disability Management

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Abstract

Building on the previous chapter’s discussion of reciprocal effects of between behavioral health issues and occupational and environmental medicine, as well as the poorly recognized contribution of administrative and medical iatrogenicity (IAG) and medically unexplained physical symptoms (MUPS) to delayed and failed recovery and unnecessary disability (DFR/UD) from work-related illness and injury, this chapter presents conceptual and practical implications of these relationships and proposals for improved management.

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Notes

  1. 1.

    WRII denotes a condition directly or indirectly caused, exacerbated, or aggravated by work activity. Examples include many musculoskeletal conditions such as sprains and strains, fractures, and acute derangements of the spinal discs, rotator cuff, and knee menisci, as well as occupational behavioral health considerations like untoward effects of excessive job stress. In contrast, WRC indicates a valid WRII complicated by additional preexisting, coincident, or consequent non-work-related influences, including alcohol or opioid dependence and tobacco abuse, fibromyalgia and other nonoccupational chronic pain syndromes, osteoarthritis (OA), and nonoccupational psychological factors (particularly preexisting mood and personality disorders).

  2. 2.

    CHPs are disorders which frequently occur in adult populations; the prototype is probably musculoskeletal (especially low back) pain. CMHPs include anxiety and depressed mood, “stress,” and periodic sleep disturbance, all of which may be normal human responses to WRII. See Chap. 8.

  3. 3.

    The American College of Occupational and Environmental Medicine (ACOEM; http://www.acoem.org/) offers a 1-day seminar for health-care professionals titled “Getting Difficult Cases Unstuck: Strategies for Stalled Recovery and Prolonged Work Disability.” Other examples include the Center for Integrated Primary Care of the University of Massachusetts Medical School (https://umassmed.edu/CIPC), the Integrated Behavioral Health Workforce Project of Antioch University (https://www.antioch.edu/new-england/resources/centers-institutes/center-behavioral-health-innovation/), and the American Psychological Association Practice Organization (http://www.apapracticecentral.org/business/collaboration/primary-care.aspx).

  4. 4.

    In my experience as a WC medical director and disability file reviewer, I have noted that routine office-based psychometric testing is becoming more prevalent. However, more often than not, the test results show up in the medical records as an isolated data point, with rare acknowledgment in impressions and plan, and no application to the claimant or claim. Sullivan (2013) observed that “The assessment of psychosocial risk factors is only worthwhile if there are plans to institute an intervention specifically designed to target these risk factors” (p. 414).

  5. 5.

    Both of these are subscription services. MDGuidelines are available at https://www.mdguidelines.com/; ODG is available at http://www.worklossdata.com/.

  6. 6.

    Franklin et al. (2013) suggested that this may be due to the basis of these guidelines on actuarial data rather than evidence-based healing periods. My anecdotal observation is that disability durations are often included in evaluation reports and even clinical progress notes, but rarely utilized in practice.

  7. 7.

    Gatchel et al. (2014) note that multidisciplinary programs may also include several different categories of experts, but that interdisciplinary programs generally involve a much higher level of focused coordination and integration among the specialties.

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  1. Occupational and Environmental Medicine, Mechanicsburg, PA, USA

    Garson M. Caruso

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    Pamela A. Warren

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Caruso, G.M. (2018). Behavioral Health Disability and Occupational Medicine: Practices. In: Warren, P. (eds) Handbook of Behavioral Health Disability Management. Springer, Cham. https://doi.org/10.1007/978-3-319-89860-5_10

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