Complex Cases: A shift in thinking

Kay Clark and Janet McPherson

• What is it?• Roles and expectations• Different rehab phases and how they

interact• Case studies• Putting it all together• Your thoughts or questions

• DVA• Catastrophic injuries• CTP• Tail claims - 10% of all claims are over 52

weeks duration*

*Australian Worker's Compensation Statistics 2011-2012: Safe Work Australia

Where do we find complex cases?

• Co-morbid conditions• Mental health condition/s• Treatment non-compliance • Drugs and/or alcohol • Previous rehab ‘failures’• Relationship difficulties• Financial strain• Compensation issues

What is a complex case?

Role of the case manager in complex cases

• Holistic assessment• Educate • Advocate• Liaison/communication• Develop trusting relationship with client:

create positive experiences• A co-facilitator of solutions not a ‘problem

fixer’• Manage expectations

• Explain RTW process and roles

• Early intervention

• Start rehab without a fitness for work

• Change your perspective about timeframes

• Small gains at a time

• A worker can move through various rehab phases at

any point in time

Managing Expectations

Phases of Rehab

• Treatment access• Multi-disciplinary and collaborative approach• Education• Appropriate treatment• Establish capacity

Medical Management

Psychosocial RehabilitationDefinition:• Psychosocial rehabilitation promotes personal recovery,

successful community integration and satisfactory quality of life for persons who have a health concern.

• Findings from research indicate that psychosocial factors are one of the main predictors of successful rehabilitation outcomes.

• World Health Organisation, 2001. International Classification of Functioning, Disability and Health.

• Worksafe Victoria, 2012. Clinical framework for the delivery of health care.

What does Psychosocial Rehab look like?

Community Engagement Support Activities

Training Volunteering

Sarah* (name changed)and Tiger *(name not changed)

Graded RTW

Work trials

Job seeking activity

RPLRetraining

Vocational assessment vs

Vocational counselling

• Facilitate relationships • Clear expectations vs flexibility

Vocational Rehabilitation

L5-S1 Disc Degeneration

Peter*

PTSD

Major Depressive Disorder

Alcohol Abuse

Right Biceps Tendon Repair

Sinus injury

Tinnitus

Bilateral Carpal Tunnel Syndrome

Bursitis Left Shoulder with impingement

Left Supraspinatus tendinopathy with impingement

*Peter: Name used with permission

Neck InjuriesConcussion

May 2015Medically

discharged from the

army.

June 2015

Commenced psychosocial

rehabilitation –Certificate III in

Dog TrainingOctober 2015

Underwent detox

January 2016Commenced

work trial

April 2016Long term

vocational goal identified –

Asbestos removal

Peter

Peter 2016

PTSD

Behavioural issues

Plantar fasciitis

Sensorineural hearing loss

Tinnitus

Lives in rural area

Frostbite – left and right feet

Cervical spondylosis with chronic headache

Indigenous

*Ben: Name has been changed

Ben

Putting it all together• Rapport is vital to a successful RTW program• A holistic and collaborative approach with all parties will assist• Re-evaluate and review on a regular basis• Manage expectations• Think outside of the box

Your thoughts or questions

Janet McPherson, BSc (Psych), B.App.Sci (OT) Hons

janet@workrehab.com.au

Kay Clark, (BOccThy)

kay@workrehab.com.au

Thank you

NEW SOUTH WALESHEAD OFFICE -SYDNEYSuite W3B5 Building 2 Sydney Corporate Park 75 O’Riordan StAlexandria NSW 2015

AUSTRALIAN CAPITAL TERRITORYCANBERRA12 Albany St,Canberra ACT 2609

SOUTH AUSTRALIAADELAIDE311 / 147 Pirie StAdelaide SA 5000

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QUEENSLANDBRISBANEUnit 2,107 Latrobe Terrace,Paddington QLD 4064

1300 856 440 info@workrehab.com.au

www.workrehab.com.au