The guidelines provided by the New York State Workers Compensation Board offer fundamental principles for addressing depression related to work. These directives are designed to assist mental health professionals in identifying appropriate approaches to managing work-related depression within the context of a comprehensive assessment.
Mental health professionals with expertise in dealing with work-related depression can rely on the guidance outlined by the Workers Compensation Board to make well-informed decisions about the most suitable therapeutic methods for their clients.
It is crucial to emphasize that these principles are not meant to replace clinical judgment or professional expertise. The approach to managing work-related depression should involve collaboration between the mental health professional and the client, taking into account individual circumstances and needs.
General Guideline Principles
Medical Care
- Medical care for work-related injuries should aim to restore functional ability necessary for daily and work activities, with a focus on returning to work and restoring health to pre-injury levels as much as possible.
Rendering Of Medical Services
- Any medical provider treating a workers’ compensation patient must adhere to the Treatment Guidelines for all work-related injuries and illnesses.
Positive Patient Response
- Positive results are defined by measurable functional gains, including positional tolerances, range of motion, strength, endurance, activities of daily living (ADL), cognition, psychological behavior, and quantifiable efficiency/velocity measures. Pain and function reports are considered if they correlate with the injury.
Re-Evaluate Treatment
- If a treatment does not yield positive results within a defined timeframe, providers should adjust or discontinue it. Evaluation of treatment efficacy should occur within 2 to 3 weeks after initiation and subsequently every 3 to 4 weeks. These timeframes may vary for mental health conditions and non-musculoskeletal medical issues.
Education
- Education of patients, families, employers, insurers, policymakers, and the community is essential in treating work-related injuries. Effective educational strategies should prioritize communication and empower patients for self-management and injury prevention.
Time Frames
Acuity
- Acute, subacute, and chronic stages are defined by timeframes:
- Acute: Less than one month
- Subacute: One to three months
- Chronic: More than three months
Initial Evaluation
- Initial evaluation refers to the acute period following an injury, not the first encounter with a physician in an office or clinical setting.
Diagnostic Time Frames
- Diagnostic testing time frames start from the date of injury, with flexibility based on clinical judgment.
Treatment Time Frames
- Treatment time frames start when treatments are initiated and may vary due to disease severity, patient compliance, and service availability, guided by clinical judgment.
Delayed Recovery
- Patients not making expected progress 6-12 weeks post-injury, with subjective symptoms not correlating with objective signs, should undergo reexamination and treatment program reevaluation. Mental health issues should be continually assessed, with early referral for mental health evaluation when indicated.
Treatment Approaches
Active Interventions
- Active interventions that emphasize patient responsibility, such as therapeutic exercise, are favored over passive modalities as treatment progresses.
Active Therapeutic Exercise Program
- Goals of an active therapeutic exercise program should include various physical and cognitive aspects, tailored to individual patient needs.
Diagnostic Imaging And Testing Procedures
- Clinical history and examination should guide diagnostic imaging selection and interpretation, with consideration of procedure risks, patient tolerance, and practitioner expertise. Repeat imaging may be necessary based on clinical course and treatment progress. Proper selection and sequencing of diagnostic procedures optimize diagnostic accuracy and minimize risks.
Surgical Interventions
- Surgery should be considered with an emphasis on expected functional improvement rather than a complete cure. Clinical findings, course of the condition, and diagnostic tests must align for surgery to be appropriate. Shared decision-making with patients is recommended, ensuring they understand the benefits, risks, and alternatives, including rehabilitation options.
Pre-Authorization
- Procedures within the Medical Treatment Guidelines criteria are considered authorized, except those listed in specific regulations. Pre-authorization is required for these exceptions and for subsequent procedures if not addressed by the guidelines.
Psychological/Psychiatric Evaluations
- Mental health evaluations are crucial for diagnosis, with the extent varying based on the nature of the claim and underlying issues. Psychological tests may aid diagnosis but cannot solely determine it. Professional interpreters should be provided if needed.
- For pre-existing mental health issues exacerbated by work-related injuries, a single initial evaluation may suffice. If further testing is necessary, it should not exceed three hours. Conditions central to the claim may require more extensive evaluations, as detailed in the guidelines.
Personality/Psychological/Psychosocial Intervention
- Interventions following evaluations should be promptly implemented, with measurable goals and time frames. Counseling aims to enhance functional recovery and should not unduly delay it.
- For PTSD intervention, the optimum duration is three to six months, with longer supervision for select patients. Continuous communication among all parties is vital for uninterrupted treatment.
Functional Capacity Evaluation (FCE)
- FCE assesses various aspects of function related to return to work, including physical, cognitive, and psychosocial factors. It may include musculoskeletal screening, cardiovascular assessment, coordination, job-specific activities, and pain evaluation.
- An FCE is typically unnecessary to determine work status but may be considered at maximum medical improvement (MMI) if the treating physician cannot make a clear determination. It should not be used early in treatment or as the sole criteria for diagnosing malingering.
Return To Work
- Returning to work, as defined here, means performing any safe task, not necessarily the patient’s regular job. Assessing return to work is integral to medical care and should be part of the treatment plan, with updates at each outpatient visit. Any limitations should be clearly stated in the plan, guiding work restrictions as needed. Prompt return to work is prioritized, as the likelihood of successful return decreases the longer a worker is out.
Job Site Evaluation
- Physicians may communicate with employers to understand job demands, such as physical tasks, repetitive actions, or environmental stressors, to assess the patient’s ability to return to their previous role. If returning to the same job is not feasible due to restrictions, modified duty options should be explored. Multiple evaluations may be necessary, ideally conducted on-site but video resources can provide valuable insight.
- Frequency: 1-2 contacts, documenting the details of each interaction.
Other
- These guidelines rely on existing medical literature and methodologies, without independent evaluation by the Workers’ Compensation Board.
- Experimental or investigational treatments not FDA-approved are not permitted under these guidelines.
- Injured workers are referred to as patients, acknowledging situations where there might not be a traditional doctor-patient relationship.
- The guidelines do not alter or define the scope of medical practice.
