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Complex Cases: A shift in thinking
Kay Clark and Janet McPherson
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• What is it?• Roles and expectations• Different rehab phases and how they
interact• Case studies• Putting it all together• Your thoughts or questions
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• 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?
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• 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?
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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
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• 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
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Phases of Rehab
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• Treatment access• Multi-disciplinary and collaborative approach• Education• Appropriate treatment• Establish capacity
Medical Management
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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.
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What does Psychosocial Rehab look like?
Community Engagement Support Activities
Training Volunteering
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Sarah* (name changed)and Tiger *(name not changed)
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Graded RTW
Work trials
Job seeking activity
RPLRetraining
Vocational assessment vs
Vocational counselling
• Facilitate relationships • Clear expectations vs flexibility
Vocational Rehabilitation
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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
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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
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Peter 2016
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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
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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
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Your thoughts or questions
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Janet McPherson, BSc (Psych), B.App.Sci (OT) Hons
Kay Clark, (BOccThy)
Thank you
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NEW SOUTH WALESHEAD OFFICE -SYDNEYSuite W3B5 Building 2 Sydney Corporate Park 75 O’Riordan StAlexandria NSW 2015
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