Date   

locked Re: Rejection emails not being sent?

 

On Wed, Apr 27, 2016 at 2:04 AM, Linda <lindon@...> wrote:

I assume a rejection notice will not be sent when a pending Integration is rejected...
 
Of course I'd never do something so stupid as .... checks source ... Umm, it's fixed now.

Thanks,
Mark 


locked Re: Note change: url as sender name:

 

On Wed, Apr 27, 2016 at 6:22 AM, Jennifer Christian <jhchristian@...> wrote:

Is having a url as the sender’s name intentional?     


It was not intentional. Fixed!

Thanks,
Mark 


locked Re: Note change: url as sender name:

James Homuth
 

I was just about to report that. Started for me it looks like yesterday at some point.


From: Jennifer Christian [mailto:jhchristian@...]
Sent: April-27-16 9:23 AM
To: beta@groups.io
Subject: [beta] Note change: url as sender name:

Is having a url as the sender’s name intentional?     

 

From: https://ACOEM-WFDSection.groups.io/g/main Notification [mailto:noreply@groups.io]
Sent: Tuesday, April 26, 2016 9:06 PM
To: jhchristian@...
Subject: Message Approval Needed - pawarren@... posted to main@ACOEM-WFDSection.groups.io

 

Hello,

A message was sent to the group https://ACOEM-WFDSection.groups.io/g/main from pawarren@... that needs to be approved:

Subject: Re: [ACOEM-WFDSection] Psychosocial issues - their place in WC

Hi Joel,
I had sent my email response from my phone last night in the 5 minutes of email window of availability that I had yesterday. After I sent my reply from my phone, my email server immediately went down again. I'm able to get on my email now and so, I wanted to respond to you.

First, several years ago, Garson Caruso, Glenn Pransky, Bob Barth and I (and I may be forgetting Jennifer Christensen, and a couple of other physicians as well.) revised the Cornerstones to Disability Prevention (Chapter 5) in ACOEM's Practice Guidelines. There was a great deal of expanded information on providing the education that you're doing with your patients. It also discussed providing an anticipated timeline of recovery and what would generally happen along the way so that the patient could better understand what was going to happen, anticipated milestones, as well as setting a RTW goal. This is a gross over-simplification of careful consideration of the multiple issues that can occur in the treatment and recovery process. Garson coined the term, "ABEs" meaning attitudes, beliefs, and expectations. This applies to physician and other treating professionals, the patient, as well as the other stakeholders. ABEs may be positive, but frequently, they're negative (e.g., "I know someone who had the same injury and surgery as me and that person never went back to work." "I'm still in pain so there must be something wrong"). These are factors that may or may not be psychosocial issues. However, they can impact RTW.

Second, the DSM-5 came into clinical use in May, 2013. It's not without its own controversies (similar to some of those that the Guides have leveled against it). As some of my colleagues who are psychologists or psychiatrists know, some disorders have remained mostly the same, while others have either been removed or changed dramatically. Dysthymic Disorder (a disorder that shares many of the characteristics with Major Depressive Disorder, but generally does not result in impairment in functioning, the symptoms have been ongoing for at least 2 years, and specifically, do not have the severity of MDD) is now called Persistent Depressive Disorder.). I'm not sure that this is an improvement since it seems more confusing in its meaning.

What used to be called Somatoform disorders in the DSM-IV-TR was felt to be confusing by the professional panel so the name of this category of disorders was changed to Somatic Symptom and Related Disorders. Previously, the DSM-IV-TR emphasized that many of these symptoms were medically unexplained symptoms. So, the panel opined that there was overlap between disorders in this diagnostic category, that the ability to determine that a somatic symptom is medically explained is limited, and "that providing a diagnosis without an explanation was problematic and reinforces mind-body dualism. Further, the panel noted that "it is not appropriate to give an individual a mental disorder diagnosis solely because a medical cause cannot be demonstrated." Lastly, "the presence of a medical diagnosis does not exclude the possibility of a comorbid mental disorder, including a somatic symptom and related disorder." Consequently, the panel employed a new classification, Somatic Symptom Disorder, "on the basis of positive symptoms abnormal thoughts, feelings, and behaviors in response to these symptoms". The quotes represent direct quotes from the DSM-5. You can find them in the SSD chapter. Conversion disorder and pseudocyesis still have medically unexplained symptoms as a key diagnostic criteria. Hypochondriasis is now Somatic Symptom Disorder (The panel felt that 75% of individuals who previously carried Hypochondriasis as a diagnosis would now have SSD as the diagnosis. It's not clear where this percentage was drawn from. It appears to be somewhat arbitrary. There are multiple differential diagnoses to confirm or rule out before making this diagnosis.

This is all background information to lay the foundation to answer your question. My first book focuses the primary psychological disorders that arise within the WC, STD, LTD, VA, and SSA settings. It addressed the still current problems that occur with either singular psychological disorders or comorbid physical and psychological disorders. It provides what are known epidemiological variables that play a role in the development of the disorder. It also focuses on empirically-supported treatments for the disorders as well as the anticipated recovery from the disorder. Let me also say that no book can realistically address every variable that impacts on psychological conditions. Thus, it's important to narrow the focus, complete the book, and then, to move to the next issues (I did so in my second book and other peer-reviewed publications.) to be addressed. I'm glad to have a back-channel conversation with you (and anyone else who is interested) to provide even more information.

Joel, the following paragraphs are the most important take-away message from this email. Yes, this group of individuals do represent a difficult set of patients to treat. While some may have Somatic Symptom Disorder, some may not. This may seem like a non-answer on the face of it. However, no clinician can simply look at diagnostic criteria and make a diagnosis from the criteria. The diagnostic criteria provide a basis of a potential diagnosis, but other diagnoses must first be ruled out in order to make a diagnosis with a strong degree of confidence in its accuracy.

How is this done? First, a truly comprehensive psychological/psychiatric evaluation. Sad to say, there are many professionals who take short-cuts (overuse of heuristics, use of screening tools, not standardized tests, ignore objective assessment altogether), perform superficial evaluations, ignore potential psychological conditions that may be occurring, and don't consider the impact of both physical conditions as well as the patient's ABEs (e.g. Garson Caruso) This cannot be emphasized strongly enough. If this part hasn't been done, then, it's uncertain as to what is actually occurring with the patient. A professional cannot say with any strong degree of certainty without a thorough evaluation since this provides the basis for understanding and conceptualization of the underlying issues at hand.

There are some screening tools that you can use that are actually designed for non-psychologists/psychiatrists. There are many others to avoid because they don't really show much of anything. Simply put, a screening tool that is designed for clinical usage is a quick way for you, or other physicians to use assess for potential ABEs upfront. However, a screening tool cannot be used to make a diagnosis. A screening tool doesn't have the same empirical support for it that a standardized psychological test has that has gone through a rigorous process to be deemed a test. A screening tool can identify a potential psychological condition that should be evaluated further. I strongly suggest that you do this first before you refer a patient to a psychologist or psychiatrist. I don't think that every patient that you see must be seen by a psychologist or psychiatrist. The better designed screening tools help to identify potential psychosocial issues or psychological conditions before treatment has begun. I frequently receive referrals for patients after they've run the gamut of treatments and have still not made significant gains. They're unhappy not only with the treatment, but also their treating professionals. I can and do work with them, but there are things to sort through at a very late stage. It takes a lot of back-tracking.

Third, if psychosocial issues are identified, then, this provides a means to start the conversation with the patient about what is going to occur when, what is to be anticipated, what the patient's responsibilities are, what you'll be doing, and that the goal is to return to work. While it may seem redundant, this is reviewed at each appointment so that any ABEs that are interferring with treatment can be addressed.

Additionally, if the screening tool identifies a psychological condition, by all means, refer the patient to a psychologist or psychiatrist who is trained in WC and RTW issues.

However, sometimes you will have patients who seem to become stuck at some point in treatment. If a patient has been referred to you from another physician, the patient may or may not have had the basic screening to sort through potential psychosocial issues or unidentified psychological conditions. Those are the patients who may have SSD. If you look at the Cornerstones of Disability Management (Chapter 5), this will give you a general timeline about when to consider psych intervention for those patients.

A lot of my practice is with the group of patients that you're discussing. If previous screening hasn't been completed, I start there. I also have patients sign a release so that I can talk with all of their treating professionals (initially, an initial evaluation report and then, updates). Treatment in a vacuum without collaboration doesn't help patients recover. I do work with patients on their over-focus on physical issues. Although it's no longer called Somatization Disorder, this diagnostic category is still the primary group of patients who have longer than anticipated recoveries, whether it's Somatization Disorder or whether it's SSD. In some patients, there is a fear of re-injury. In others, there may be primary gains which the patient is conscious of the potential gain. Typically, the physical condition may become aggravated in certain settings or activities. In this way, the increased physical conditions result in the patient withdrawing (repeatedly). Primary gains are different from secondary gains because the individual is conscious of them and there is some type of reward (e.g., increased attention from a loved one, avoidance of a perceived unpleasant task or situation, or monetary). Many patients are focused on what their attorneys have told them in regards to the value of their claim. In others, they may have some type of injury/harm (real or perceived) done to them before the injury. These issues that I just noted are the primary areas to address in treatment.

Lastly, the empirical literature is clear that many individuals with chronic pain typically have a comorbid psychological condition (e.g., Major Depressive Disorder or one of the Anxiety Disorders). The good news is that there is very clear empirically-supported treatment to help the patient recover from those conditions. I also tell that to my patients and that recovery is the expected outcome, not the exception. This is because there are empirically-supported treatments for the majority of psychological conditions so that the person is restored to the previously level of functioning.

So, to recap:
1) Read the Cornerstones for Disability Management. A great resource that you may already have and can use to use psychology/psychiatry in specific areas of the treatment process. You don't need to send all patients to a psych professional.

2) There are solid screening tools specifically designed for clinical settings. Because of the potential of appearing to promote certain tools over others, I'm not providing names here. The tools that I recommend are available commercially and I have no financial gain from them. Instead, they have reliability and validity indices built into them for more confidence in what the results mean. I'm glad to do so in backchannel communications.

3) Provide education to each patient at the start of treatment to set their expectations, redirect their misperceptions, and to enlist their active participation in their treatment. Do this at each and every appointment. It may seem tiresome. Once you've trained/shaped your patients' expectations, they know what to expect from you, what their responsibilities are, the anticipated milestones and the RTW goal, you begin to address problems as they arise, correct problematic thinking, and improve treatment outcomes. It provides a means to discuss problematic areas to get the patient back on track.

4) If the screening tool indicates that psychosocial concerns are likely to exist, sit down with your patient and discuss them candidly. There's no need to beat around the bush. Be transparent about the results. Use it as an opportunity to acknowledge and address the concerns.

5) If the screening tool is indicative of potential psychological conditions, refer the patient on immediately for psychotropic medications (Psychiatrists typically provide medications at dosage sufficient to treat the conditions, while PCPs generally tend to prescribe insufficient dosages, which leads to poor treatment outcomes). Work with a psychologists who is trained in WC and RTW issues and will collaborate with you actively. Psychological care should not be open-ended care and should not preclude the patient from returning to work. The patient can continue to receive psychological care while working.

6) When you have those patients who don't get better or stuck, despite your best efforts, you need to enlist the help of a psychologist skilled in standardized psychological testing. It's far better to identify a psychological condition and treat it than not. Untreated psychological conditions are directly related to poor treatment outcomes and poor RTW.

So, at the end of a very lengthy email response, there are some things that you can do. Please send a back-channel email to me and I will put you in touch with solid, reliable resources that you can use. For the record, please do not buy my book. It's a great book. But, I'm not here to drum up sales for it. There are other ways for you to address these concerns with your patients.

Best,
Pam











Pamela A. Warren, Ph.D.

----- Original Message -----

From: "Joel Weddington" <joelweddington@...>
To: main@ACOEM-WFDSection.groups.io
Sent: Monday, April 25, 2016 5:46:25 PM
Subject: Re: [ACOEM-WFDSection] Psychosocial issues - their place in WC

Hi Pam,

Reading your excellent input, my first impulse is to order your book as you are clearly an appreciated authority. As an occupational orthopedist Im spending increasing time talking patients through fear avoidance and educating about diet-exercise, but as I indicated in a recent post in this thread, I seem to have ncovered a whole sector with musculoskeletal pain that wont get better and RTW due to affliction with somatic disorders , and they are being overlooked. I'd like to benefit from work thats been done by you and others, apply it to these injured workers, and share it with my occ med colleagues and specialists I work with in a large mult-center group. But the preface to your book indicates it addressed major depressive disorder, dysthymic disorder (neurotic depression), bipolar disorder, generalized anxiety disorder, panic disorder, posttraumatic stress disorder and obsessive compulsive disorder.
When I read DSM-5 on the SSDs (not addressed in your book?), lights go on about why many IWs arent getting better. In addition to doing my own diagnosis and correlations, and starting to recommend nonindustrial psych eval and treatment, do you have any resources to point me to so I can take better care of these folks who often become chronically and even totally disabled with obvious SSDs? (They also can present as difficult patients and end up getting unnecessary tests and treatment). Thanks,

Joel Weddington MD

On Thu, Apr 21, 2016 at 5:33 PM, Pamela A Warren < pawarren@... > wrote:



Doug,
Thanks for your email reply. I'm glad that you've worked with and learned from Bob Barth. I think highly of him, professionally. You're right. His work is exceptional.

I think around the time you both were working together, I had been working with the Work Loss Data Institute and published my first book, The Management of Workplace Mental Health Issues and Appropriate Disability Prevention Strategies . This book provided a comprehensive review of empirical research for multiple psychological conditions, not just Major Depressive Disorder and one or two anxiety disorders. My book was a best practice standards for these disorders. It provided epidemiological data regarding these psychological conditions. In addition, it evaluated psychological treatments that were empirically-supported, including treatments, such as CBT, appropriate medications, ECT, length of appropriate treatment, etc. I was also working (and continue to do so) with the Disability Management Employers Coalition, a professional group, that is comprised of some small, but mostly medium- to large-sized nationally based companies. Some federal agencies, such as the U.S. Post Office are also professional members. In addition, many national insurers come to DMEC conferences so that this provides a environment in which those two groups can discuss multiple disability issues, including what constitutes appropriate care.

My first book was recognized by the Partnership for Workplace Mental Health (a branch of the American Psychiatric Association) as one of the four primary resources to help employers and other professionals in addressing workplace psychological concerns as well as return to work issues. I was/am extremely honored to be included in this group of resources, since one of the other resources noted was highly distinguished professionals: Jim Talmage, Mark Hyman, and Mark Melhorn's book, AMA Guides to the Evaluation of Work Ability and Return to Work . I mention this because I think that you, Bob, and I have worked on similar workplace issues, but in different settings with different types of professionals. Over the past 16 years, I've continued to publish and work with a variety of companies, organizations and professionals, provided training, and offered empirically-based solutions, both on a small and large-scale. I'm a believer in an evidence-based approach and the tremendous difference it makes as opposed usual care (in any field).

I do note, though, that many times, single studies, poorly designed studies, dated techniques, overly-generous interpretations of treatments, data, and results are, at times, offered up as novel and compelling. This can promote continuation of misperceptions about what constitutes quality of care, appropriate treatment, and even, that this information is new or innovative, when it's not. It's concerning to see this type of response from laypeople and professionals alike, because it inevitably sustains misperceptions about how this translates to everyday treatment, but also how it can be applied to settings, such as the workplace. I suspect you have the same that occurs in your profession as well. Much of my work involves how to consistently apply strong scientific knowledge, data/evidence across all aspects of my work. I look forward to discussions, like with this professional listserv, to both learn from others and to share my professional knowledge. It facilitates cross-pollination, if you will, across professions. It also serves to promote thinking beyond the status quo.

These types of issues also occur in the WC setting. You had mentioned some of these problems, such as having professionals who opine about issues well-beyond their professional training and scope of competency. Doug, I know that you're aware of the Daubert standard. Like you, I've served as an expert witness in State (multiple) and Federal court. I even served as an expert witness in international court in South Africa. The issue in this discussion isn't really what you or I know professionally or whether we both understand the Daubert standard and its implications. The reason that I brought up Daubert is that it provides a means to refute low-level/garbage science and questionable professional opinion. I'm specifically focusing all of my discussion on psychosocial issues solely. While many States don't use Daubert, it is quite interesting that some States ARE beginning to incorporate Daubert into the State's WC laws. It says that, at least, some States are recognizing the problematic legal quagmire that is the WC system (State and federal). This change is coming about because of the recognition of junk science being offered as objective evidence, when it's not and that not all professionals are actually able to opine when they don't have the professional training to do so in the first place. It is an interesting trend since several States have now adopted it. Will it spread to other States? Who knows. However, if more like-minded professionals like those on this listserv continue to promote some of the issues we discuss, it may have further effect on some of the problematic issues that have been brought up in this discussion thread.

The article I just submitted for publication also addresses how the AMA Guides (strengths and weaknesses) impact on WC psychological injury. The reasons why some States have chosen to remain with earlier versions illustrates the sustained misunderstanding of the purpose of Guides. It demonstrates a lack of understanding of the need for a more standardized process in disability evaluation. There's still a strongly-held belief across many States that the Guides are harmful to injured employees and it causes them to receive less money. Really, there are multiple factors regarding the monetary aspect, including increased payment to attorneys (both defense and plaintiff), increased treatment costs, and increased administrative costs. So, there's a smaller piece of the pie that is distributed to the injured employee. There's also a lack of understanding that impairment and disability on a continuum versus an either/or point of view. This isn't true just for physical conditions, but for psychological conditions as well. I already know that you understand the Guides quite well. Again, I'm only focusing psychological injury and separating psychosocial issues from psychological conditions and it how pertains to this discussion thread.

I understand the points you're making about the divide between the legal decision-making process versus the medical or psychological decision-making process. It's dumbfounding to see WC decisions that are made by Commissioners and Arbitrators. There are similar illogical decisions can be found in the federal system as well. I have no doubt about the problems you noted about Iowa. However, that doesn't mean all states have similar problems. Again, the focus is on psychological injury and psychosocial issues. The thing is, that unless we keep promoting strong science, empirically-supported treatment, the biopsychosocial model, and employing standards like Daubert, then the dysfunctional WC systems just stay the same. Like Iowa, some unbelievable decisions have been made by the IL WC arbitrators that can make one's blood pressure sky-rocket. I work in the IL, OH, IN, and WI WC systems, and so, I have seen movement towards the use of a more standardized approach and rejecting unsupportable professional opinions and junk science. I also provide file and peer review for the States of FL, IL, IN, NH, NM, OH, OK, PA, TX, WI. pertaining to WC psychological injury and see similar movement towards the use of objective data that is well-accepted by the scientific community.

Where does this leave us? I think there's far more that you and I agree upon than we disagree.

Best,
Pam


Pamela A. Warren, Ph.D.


From: "Douglas W Martin" < Douglas.Martin@... >
To: main@ACOEM-WFDSection.groups.io
Sent: Thursday, April 21, 2016 9:13:28 AM

Subject: Re: [ACOEM-WFDSection] Psychosocial issues - their place in WC



Thanks for your detailed response. I support your position and am fortunate to have learned much regarding psychological issues from my AADEP colleague Bob Barth who has taught with me at AADEP courses for many years. He is exemplary when it comes to providing literature support and has also made many of the points that you have expressed below. I am well aware of the Daubert standard and have been through one Daubert challenge as an expert witness.



Many state WC systems however do not use the Daubert standard. Iowa is one of them, unfortunately. In Iowa, when I go and testify at an Industrial Commissioner hearing, my opinion is given the same weight as a chiropractor, naturopath, physical therapist, etc. It is incumbent upon the commissioner to try to figure out who is right, and even though I explain the literature, often the decision is counter to science. We really do have “work related fibromyalgia”. For those OCD, you can go here:



http://decisions.iowaworkforce.org/workerscomp/Pages/default.aspx



and just type in fibromyalgia in the search bar. You can then type in any number of psychological descriptors and look at those.



Click on any number of the decisions and you will see what science, medicine, and myself battle in this wonderful state.



Douglas W. Martin, MD, FAADEP, FACOEM, FAAFP

Medical Director

UnityPoint Clinic – Occupational Medicine

4230 War Eagle Drive

Sioux City, IA 51109



712-224-4300

712-224-4302 (fax)



Past President – American Academy of Disability Evaluating Physicians

Past President – Iowa Academy of Family Physicians



From: Pamela A Warren [mailto: pawarren@... ]
Sent: Wednesday, April 20, 2016 8:42 PM
To: main@ACOEM-WFDSection.groups.io
Subject: Re: [ACOEM-WFDSection] Psychosocial issues - their place in WC




Doug,


Ah, I see the point you're making. From my professional vantage point, it really is that psychosocial issues are never compensable. That's what I write in my reports. For my discussion below, let's clearly separate psychosocial issues from psychological conditions. Psychosocial issues cannot be objectively found to cause injury because they are perceptions/beliefs/preferences. Psychological conditions may be found to caused a psychological injury.





Here's why, psychosocial issues lack diagnostic criteria. How does a professional demonstrate the existence of a psychosocial issue if it cannot be diagnosed? The diagnostic criteria are critical since these detail the types of impairment in functioning that the individual with a valid condition is likely to experience. A valid psychological condition has diagnostic criteria that note the parameters of that condition. Psychosocial issues do not. Psychosocial issues vary across individuals. Since this is the case, it is an uphill battle for an attorney to attempt to assert injury for something that isn't recognized as a valid condition by the pertinent scientific community. Think Daubert standard. Daubert standard requires that professional testimony and evidence must demonstrate: a) reliability and include data objective and reliable and not merely a subjective opinion. In addition, any methodology or treatment must be peer-reviewed. Any testimony and treatment with potential rate of error and standards are known and controlled. There are standards and conditions under which methodology is conducted. Final requirement: there must be general consensus of the scientific community in regards to treatment and methodology utilized.





Consequently, an attorney may try to build the case for causation and will. However, for causation to be demonstrated in the case of psychosocial issues, the attorney must demonstrate that a preponderance of evidence makes the reported impairment more likely than not to have occurred. This is the But-for test. Since psychosocial issues are subjective opinion, do not result in impairment in functioning and are not objective in nature, that means the attorney is putting forth a lot of effort to argue that a perception/subjective opinion is the purported injury. Would this stand up to the Daubert standard or a challenge. No. There isn't a way to reliably measure a psychosocial issue that produces objective data that is indicative of psychological injury and/or impairment in functioning. It is merely subjective opinion. There is no standard of care to treat subjective opinion as a stand-alone condition. We do have ways to objective document the existence of psychosocial issues in WC/STD/LTD claims. There is general consensus that psychosocial issues are not injuries or valid conditions, but do influence treatment outcomes. This would mean that the But-for test could not be met.








Instead, it is far easier for the attorney to argue proximate cause. However, many States, such as FL and others have recently introduced the Daubert standard (by law) into the WC treatment and disability claims process. Thus, it is no longer sufficient to merely demonstrate cause-in-fact or proximate cause to a purported event. Instead, causation testimony and evidence in those States must now also meet the Daubert standard. This type of inclusion of current scientific consensus and methodology raises the bar to conclusively prove causation. Moreover in WC, causation can be a moot point if the State (such as Montana) doesn't recognize mental-mental claims. Thus, in Montana neither psychosocial issues or psychological conditions can be WC injuries.





I just finished writing an article on psychological injury in WC (State and Federal) that will be published in the upcoming Special Work Comp Issue of the Psychological Injury and Law journal. Here are a couple of paragraphs from that article illustrating some of the points that I'm noting:





An example of a State which allows a mental-mental claim, with certain qualifying factors is Tennessee (TN). In order for a mental-mental claim to be considered within the TN Workers' Compensation system, there two conditions that must be met . First, the psychological injury must stem from an identifiable stressful, work-related situation that produces a sudden mental effect, such as shock, fright, or excessive anxiety. Second, the event must be extraordinary in comparison to the stress that is typically experienced by an employee in the same type of duty. Thus, not all purported mental-mental TN WC claims are approved. Recently, the Tennessee Special Workers’ Compensation Appeals Panel affirmed a trial court’s denial of registered nurse'c WC claim who worked in a variety of psychiatric treatment units since 1986. The employee claimed psychological injuries of Major Depressive Disorder and Post Traumatic Stress Disorder (PTSD) caused by workplace stress. The Special WC Appeals Panel found that the evidence did not support that the employee was exposed to an unusual amount of work stress and that his purported injuries were not abnormal, extraordinary, or unusual when viewed under the objective standard (Ireton v. Horizon Mental Health Mgmt., LLC, 2016 Tenn.).



In regards to psychological injury, the State of Florida (FL) does not allow mental-mental claims. Instead, any mental health condition that is said to arise from the workplace must have occurred related to physical workplace injury only. Moreover, in the past two years, in regards to WC claims, FL has introduced Daubert into its WC laws. Thus, if a workplace psychological injury is said to occur, then, the assessment and treatment of the psychological injury must meet the Daubert standard that was discussed earlier. By taking this stance, FL requires any purported psychological impairment to have been assessed meeting current standards of care, regarding the evaluation, treatment, and assessment of a reported psychological condition, such as the American Psychological Association's Testing standards. Moreover, by using Daubert standard, the State of Florida has greatly narrowed the window of the physical-mental claims being allowed because they must be objectively determined to exist and that any psychological injury must be periodically be re-assessed through the life of the claim. If the claimant attempted to argue permanent psychological injury related to a physical workplace injury, then, this stand may backfire since the psychological injury would improve both in receiving empirically-supported psychological and psychiatric treatment and also, once the individual is out of the workplace. Importantly, the majority of psychological conditions are not permanent in nature, this would mean that the likelihood of a permanent psychological injury claim being approved to be greatly reduced.





Another example that just recently occurred when a WC claim in which the employee claimed psychological injury when his supervisor was reported to have made derogatory comments about the employee. The State held that there was no psychological injury. Instead, it was the employee's perception of injury which was the impetus of the filing of the claim. There a preponderance of evidence that did not support the claim. Thus, it was denied.





So, although I stated my opinion more concisely in my earlier email, I wanted to explain what I mean in more detail with this email.





Thanks,


Pam





Pamela A. Warren, Ph.D.






From: "Douglas W Martin" < Douglas.Martin@... >
To: main@ACOEM-WFDSection.groups.io
Sent: Wednesday, April 20, 2016 7:15:04 AM
Subject: Re: [ACOEM-WFDSection] Psychosocial issues - their place in WC





Agree with everything in that psychosocial issues are at the core of the development of the SPICE Model whose purpose is to prevent iatrogenic disability.



I would point out one item, Pam……I think you mean that “Psychosocial issues SHOULD never be compensable”. I have long since learned that there is a huge difference in the workers compensation world between compensability and causation. Thus, for example in Iowa, we have “work related fibromyalgia”, “work caused DJD of bilateral weight bearing joints”, etc. Of course, science is clear that these do not exist and should not be compensable, but the reality is that legal trumps medical and we then have to “deal with it”. Also, it has been my experience that many claims examiners will “authorize” evaluation and even treatment for psychosocial problems without giving a thought to causation analysis.



Thanks.



Douglas W. Martin, MD, FAADEP, FACOEM, FAAFP

Medical Director

UnityPoint Clinic – Occupational Medicine

4230 War Eagle Drive

Sioux City, IA 51109



712-224-4300

712-224-4302 (fax)



Past President – American Academy of Disability Evaluating Physicians

Past President – Iowa Academy of Family Physicians



[Moderator note - in response to:]



"...You're right. Psychosocial issues are never compensable. These issues are quirks, perceptions, and preferences. Psychosocial issues aren't valid psychological conditions. Yet, they're right there, front and center in both the treatment process and disability process...











Pam"

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locked Note change: url as sender name:

Jennifer Christian
 

Is having a url as the sender’s name intentional?     

 

From: https://ACOEM-WFDSection.groups.io/g/main Notification [mailto:noreply@groups.io]
Sent: Tuesday, April 26, 2016 9:06 PM
To: jhchristian@...
Subject: Message Approval Needed - pawarren@... posted to main@ACOEM-WFDSection.groups.io

 

Hello,

A message was sent to the group https://ACOEM-WFDSection.groups.io/g/main from pawarren@... that needs to be approved:

Subject: Re: [ACOEM-WFDSection] Psychosocial issues - their place in WC

Hi Joel,
I had sent my email response from my phone last night in the 5 minutes of email window of availability that I had yesterday. After I sent my reply from my phone, my email server immediately went down again. I'm able to get on my email now and so, I wanted to respond to you.

First, several years ago, Garson Caruso, Glenn Pransky, Bob Barth and I (and I may be forgetting Jennifer Christensen, and a couple of other physicians as well.) revised the Cornerstones to Disability Prevention (Chapter 5) in ACOEM's Practice Guidelines. There was a great deal of expanded information on providing the education that you're doing with your patients. It also discussed providing an anticipated timeline of recovery and what would generally happen along the way so that the patient could better understand what was going to happen, anticipated milestones, as well as setting a RTW goal. This is a gross over-simplification of careful consideration of the multiple issues that can occur in the treatment and recovery process. Garson coined the term, "ABEs" meaning attitudes, beliefs, and expectations. This applies to physician and other treating professionals, the patient, as well as the other stakeholders. ABEs may be positive, but frequently, they're negative (e.g., "I know someone who had the same injury and surgery as me and that person never went back to work." "I'm still in pain so there must be something wrong"). These are factors that may or may not be psychosocial issues. However, they can impact RTW.

Second, the DSM-5 came into clinical use in May, 2013. It's not without its own controversies (similar to some of those that the Guides have leveled against it). As some of my colleagues who are psychologists or psychiatrists know, some disorders have remained mostly the same, while others have either been removed or changed dramatically. Dysthymic Disorder (a disorder that shares many of the characteristics with Major Depressive Disorder, but generally does not result in impairment in functioning, the symptoms have been ongoing for at least 2 years, and specifically, do not have the severity of MDD) is now called Persistent Depressive Disorder.). I'm not sure that this is an improvement since it seems more confusing in its meaning.

What used to be called Somatoform disorders in the DSM-IV-TR was felt to be confusing by the professional panel so the name of this category of disorders was changed to Somatic Symptom and Related Disorders. Previously, the DSM-IV-TR emphasized that many of these symptoms were medically unexplained symptoms. So, the panel opined that there was overlap between disorders in this diagnostic category, that the ability to determine that a somatic symptom is medically explained is limited, and "that providing a diagnosis without an explanation was problematic and reinforces mind-body dualism. Further, the panel noted that "it is not appropriate to give an individual a mental disorder diagnosis solely because a medical cause cannot be demonstrated." Lastly, "the presence of a medical diagnosis does not exclude the possibility of a comorbid mental disorder, including a somatic symptom and related disorder." Consequently, the panel employed a new classification, Somatic Symptom Disorder, "on the basis of positive symptoms abnormal thoughts, feelings, and behaviors in response to these symptoms". The quotes represent direct quotes from the DSM-5. You can find them in the SSD chapter. Conversion disorder and pseudocyesis still have medically unexplained symptoms as a key diagnostic criteria. Hypochondriasis is now Somatic Symptom Disorder (The panel felt that 75% of individuals who previously carried Hypochondriasis as a diagnosis would now have SSD as the diagnosis. It's not clear where this percentage was drawn from. It appears to be somewhat arbitrary. There are multiple differential diagnoses to confirm or rule out before making this diagnosis.

This is all background information to lay the foundation to answer your question. My first book focuses the primary psychological disorders that arise within the WC, STD, LTD, VA, and SSA settings. It addressed the still current problems that occur with either singular psychological disorders or comorbid physical and psychological disorders. It provides what are known epidemiological variables that play a role in the development of the disorder. It also focuses on empirically-supported treatments for the disorders as well as the anticipated recovery from the disorder. Let me also say that no book can realistically address every variable that impacts on psychological conditions. Thus, it's important to narrow the focus, complete the book, and then, to move to the next issues (I did so in my second book and other peer-reviewed publications.) to be addressed. I'm glad to have a back-channel conversation with you (and anyone else who is interested) to provide even more information.

Joel, the following paragraphs are the most important take-away message from this email. Yes, this group of individuals do represent a difficult set of patients to treat. While some may have Somatic Symptom Disorder, some may not. This may seem like a non-answer on the face of it. However, no clinician can simply look at diagnostic criteria and make a diagnosis from the criteria. The diagnostic criteria provide a basis of a potential diagnosis, but other diagnoses must first be ruled out in order to make a diagnosis with a strong degree of confidence in its accuracy.

How is this done? First, a truly comprehensive psychological/psychiatric evaluation. Sad to say, there are many professionals who take short-cuts (overuse of heuristics, use of screening tools, not standardized tests, ignore objective assessment altogether), perform superficial evaluations, ignore potential psychological conditions that may be occurring, and don't consider the impact of both physical conditions as well as the patient's ABEs (e.g. Garson Caruso) This cannot be emphasized strongly enough. If this part hasn't been done, then, it's uncertain as to what is actually occurring with the patient. A professional cannot say with any strong degree of certainty without a thorough evaluation since this provides the basis for understanding and conceptualization of the underlying issues at hand.

There are some screening tools that you can use that are actually designed for non-psychologists/psychiatrists. There are many others to avoid because they don't really show much of anything. Simply put, a screening tool that is designed for clinical usage is a quick way for you, or other physicians to use assess for potential ABEs upfront. However, a screening tool cannot be used to make a diagnosis. A screening tool doesn't have the same empirical support for it that a standardized psychological test has that has gone through a rigorous process to be deemed a test. A screening tool can identify a potential psychological condition that should be evaluated further. I strongly suggest that you do this first before you refer a patient to a psychologist or psychiatrist. I don't think that every patient that you see must be seen by a psychologist or psychiatrist. The better designed screening tools help to identify potential psychosocial issues or psychological conditions before treatment has begun. I frequently receive referrals for patients after they've run the gamut of treatments and have still not made significant gains. They're unhappy not only with the treatment, but also their treating professionals. I can and do work with them, but there are things to sort through at a very late stage. It takes a lot of back-tracking.

Third, if psychosocial issues are identified, then, this provides a means to start the conversation with the patient about what is going to occur when, what is to be anticipated, what the patient's responsibilities are, what you'll be doing, and that the goal is to return to work. While it may seem redundant, this is reviewed at each appointment so that any ABEs that are interferring with treatment can be addressed.

Additionally, if the screening tool identifies a psychological condition, by all means, refer the patient to a psychologist or psychiatrist who is trained in WC and RTW issues.

However, sometimes you will have patients who seem to become stuck at some point in treatment. If a patient has been referred to you from another physician, the patient may or may not have had the basic screening to sort through potential psychosocial issues or unidentified psychological conditions. Those are the patients who may have SSD. If you look at the Cornerstones of Disability Management (Chapter 5), this will give you a general timeline about when to consider psych intervention for those patients.

A lot of my practice is with the group of patients that you're discussing. If previous screening hasn't been completed, I start there. I also have patients sign a release so that I can talk with all of their treating professionals (initially, an initial evaluation report and then, updates). Treatment in a vacuum without collaboration doesn't help patients recover. I do work with patients on their over-focus on physical issues. Although it's no longer called Somatization Disorder, this diagnostic category is still the primary group of patients who have longer than anticipated recoveries, whether it's Somatization Disorder or whether it's SSD. In some patients, there is a fear of re-injury. In others, there may be primary gains which the patient is conscious of the potential gain. Typically, the physical condition may become aggravated in certain settings or activities. In this way, the increased physical conditions result in the patient withdrawing (repeatedly). Primary gains are different from secondary gains because the individual is conscious of them and there is some type of reward (e.g., increased attention from a loved one, avoidance of a perceived unpleasant task or situation, or monetary). Many patients are focused on what their attorneys have told them in regards to the value of their claim. In others, they may have some type of injury/harm (real or perceived) done to them before the injury. These issues that I just noted are the primary areas to address in treatment.

Lastly, the empirical literature is clear that many individuals with chronic pain typically have a comorbid psychological condition (e.g., Major Depressive Disorder or one of the Anxiety Disorders). The good news is that there is very clear empirically-supported treatment to help the patient recover from those conditions. I also tell that to my patients and that recovery is the expected outcome, not the exception. This is because there are empirically-supported treatments for the majority of psychological conditions so that the person is restored to the previously level of functioning.

So, to recap:
1) Read the Cornerstones for Disability Management. A great resource that you may already have and can use to use psychology/psychiatry in specific areas of the treatment process. You don't need to send all patients to a psych professional.

2) There are solid screening tools specifically designed for clinical settings. Because of the potential of appearing to promote certain tools over others, I'm not providing names here. The tools that I recommend are available commercially and I have no financial gain from them. Instead, they have reliability and validity indices built into them for more confidence in what the results mean. I'm glad to do so in backchannel communications.

3) Provide education to each patient at the start of treatment to set their expectations, redirect their misperceptions, and to enlist their active participation in their treatment. Do this at each and every appointment. It may seem tiresome. Once you've trained/shaped your patients' expectations, they know what to expect from you, what their responsibilities are, the anticipated milestones and the RTW goal, you begin to address problems as they arise, correct problematic thinking, and improve treatment outcomes. It provides a means to discuss problematic areas to get the patient back on track.

4) If the screening tool indicates that psychosocial concerns are likely to exist, sit down with your patient and discuss them candidly. There's no need to beat around the bush. Be transparent about the results. Use it as an opportunity to acknowledge and address the concerns.

5) If the screening tool is indicative of potential psychological conditions, refer the patient on immediately for psychotropic medications (Psychiatrists typically provide medications at dosage sufficient to treat the conditions, while PCPs generally tend to prescribe insufficient dosages, which leads to poor treatment outcomes). Work with a psychologists who is trained in WC and RTW issues and will collaborate with you actively. Psychological care should not be open-ended care and should not preclude the patient from returning to work. The patient can continue to receive psychological care while working.

6) When you have those patients who don't get better or stuck, despite your best efforts, you need to enlist the help of a psychologist skilled in standardized psychological testing. It's far better to identify a psychological condition and treat it than not. Untreated psychological conditions are directly related to poor treatment outcomes and poor RTW.

So, at the end of a very lengthy email response, there are some things that you can do. Please send a back-channel email to me and I will put you in touch with solid, reliable resources that you can use. For the record, please do not buy my book. It's a great book. But, I'm not here to drum up sales for it. There are other ways for you to address these concerns with your patients.

Best,
Pam











Pamela A. Warren, Ph.D.

----- Original Message -----

From: "Joel Weddington" <joelweddington@...>
To: main@ACOEM-WFDSection.groups.io
Sent: Monday, April 25, 2016 5:46:25 PM
Subject: Re: [ACOEM-WFDSection] Psychosocial issues - their place in WC

Hi Pam,

Reading your excellent input, my first impulse is to order your book as you are clearly an appreciated authority. As an occupational orthopedist Im spending increasing time talking patients through fear avoidance and educating about diet-exercise, but as I indicated in a recent post in this thread, I seem to have ncovered a whole sector with musculoskeletal pain that wont get better and RTW due to affliction with somatic disorders , and they are being overlooked. I'd like to benefit from work thats been done by you and others, apply it to these injured workers, and share it with my occ med colleagues and specialists I work with in a large mult-center group. But the preface to your book indicates it addressed major depressive disorder, dysthymic disorder (neurotic depression), bipolar disorder, generalized anxiety disorder, panic disorder, posttraumatic stress disorder and obsessive compulsive disorder.
When I read DSM-5 on the SSDs (not addressed in your book?), lights go on about why many IWs arent getting better. In addition to doing my own diagnosis and correlations, and starting to recommend nonindustrial psych eval and treatment, do you have any resources to point me to so I can take better care of these folks who often become chronically and even totally disabled with obvious SSDs? (They also can present as difficult patients and end up getting unnecessary tests and treatment). Thanks,

Joel Weddington MD

On Thu, Apr 21, 2016 at 5:33 PM, Pamela A Warren < pawarren@... > wrote:



Doug,
Thanks for your email reply. I'm glad that you've worked with and learned from Bob Barth. I think highly of him, professionally. You're right. His work is exceptional.

I think around the time you both were working together, I had been working with the Work Loss Data Institute and published my first book, The Management of Workplace Mental Health Issues and Appropriate Disability Prevention Strategies . This book provided a comprehensive review of empirical research for multiple psychological conditions, not just Major Depressive Disorder and one or two anxiety disorders. My book was a best practice standards for these disorders. It provided epidemiological data regarding these psychological conditions. In addition, it evaluated psychological treatments that were empirically-supported, including treatments, such as CBT, appropriate medications, ECT, length of appropriate treatment, etc. I was also working (and continue to do so) with the Disability Management Employers Coalition, a professional group, that is comprised of some small, but mostly medium- to large-sized nationally based companies. Some federal agencies, such as the U.S. Post Office are also professional members. In addition, many national insurers come to DMEC conferences so that this provides a environment in which those two groups can discuss multiple disability issues, including what constitutes appropriate care.

My first book was recognized by the Partnership for Workplace Mental Health (a branch of the American Psychiatric Association) as one of the four primary resources to help employers and other professionals in addressing workplace psychological concerns as well as return to work issues. I was/am extremely honored to be included in this group of resources, since one of the other resources noted was highly distinguished professionals: Jim Talmage, Mark Hyman, and Mark Melhorn's book, AMA Guides to the Evaluation of Work Ability and Return to Work . I mention this because I think that you, Bob, and I have worked on similar workplace issues, but in different settings with different types of professionals. Over the past 16 years, I've continued to publish and work with a variety of companies, organizations and professionals, provided training, and offered empirically-based solutions, both on a small and large-scale. I'm a believer in an evidence-based approach and the tremendous difference it makes as opposed usual care (in any field).

I do note, though, that many times, single studies, poorly designed studies, dated techniques, overly-generous interpretations of treatments, data, and results are, at times, offered up as novel and compelling. This can promote continuation of misperceptions about what constitutes quality of care, appropriate treatment, and even, that this information is new or innovative, when it's not. It's concerning to see this type of response from laypeople and professionals alike, because it inevitably sustains misperceptions about how this translates to everyday treatment, but also how it can be applied to settings, such as the workplace. I suspect you have the same that occurs in your profession as well. Much of my work involves how to consistently apply strong scientific knowledge, data/evidence across all aspects of my work. I look forward to discussions, like with this professional listserv, to both learn from others and to share my professional knowledge. It facilitates cross-pollination, if you will, across professions. It also serves to promote thinking beyond the status quo.

These types of issues also occur in the WC setting. You had mentioned some of these problems, such as having professionals who opine about issues well-beyond their professional training and scope of competency. Doug, I know that you're aware of the Daubert standard. Like you, I've served as an expert witness in State (multiple) and Federal court. I even served as an expert witness in international court in South Africa. The issue in this discussion isn't really what you or I know professionally or whether we both understand the Daubert standard and its implications. The reason that I brought up Daubert is that it provides a means to refute low-level/garbage science and questionable professional opinion. I'm specifically focusing all of my discussion on psychosocial issues solely. While many States don't use Daubert, it is quite interesting that some States ARE beginning to incorporate Daubert into the State's WC laws. It says that, at least, some States are recognizing the problematic legal quagmire that is the WC system (State and federal). This change is coming about because of the recognition of junk science being offered as objective evidence, when it's not and that not all professionals are actually able to opine when they don't have the professional training to do so in the first place. It is an interesting trend since several States have now adopted it. Will it spread to other States? Who knows. However, if more like-minded professionals like those on this listserv continue to promote some of the issues we discuss, it may have further effect on some of the problematic issues that have been brought up in this discussion thread.

The article I just submitted for publication also addresses how the AMA Guides (strengths and weaknesses) impact on WC psychological injury. The reasons why some States have chosen to remain with earlier versions illustrates the sustained misunderstanding of the purpose of Guides. It demonstrates a lack of understanding of the need for a more standardized process in disability evaluation. There's still a strongly-held belief across many States that the Guides are harmful to injured employees and it causes them to receive less money. Really, there are multiple factors regarding the monetary aspect, including increased payment to attorneys (both defense and plaintiff), increased treatment costs, and increased administrative costs. So, there's a smaller piece of the pie that is distributed to the injured employee. There's also a lack of understanding that impairment and disability on a continuum versus an either/or point of view. This isn't true just for physical conditions, but for psychological conditions as well. I already know that you understand the Guides quite well. Again, I'm only focusing psychological injury and separating psychosocial issues from psychological conditions and it how pertains to this discussion thread.

I understand the points you're making about the divide between the legal decision-making process versus the medical or psychological decision-making process. It's dumbfounding to see WC decisions that are made by Commissioners and Arbitrators. There are similar illogical decisions can be found in the federal system as well. I have no doubt about the problems you noted about Iowa. However, that doesn't mean all states have similar problems. Again, the focus is on psychological injury and psychosocial issues. The thing is, that unless we keep promoting strong science, empirically-supported treatment, the biopsychosocial model, and employing standards like Daubert, then the dysfunctional WC systems just stay the same. Like Iowa, some unbelievable decisions have been made by the IL WC arbitrators that can make one's blood pressure sky-rocket. I work in the IL, OH, IN, and WI WC systems, and so, I have seen movement towards the use of a more standardized approach and rejecting unsupportable professional opinions and junk science. I also provide file and peer review for the States of FL, IL, IN, NH, NM, OH, OK, PA, TX, WI. pertaining to WC psychological injury and see similar movement towards the use of objective data that is well-accepted by the scientific community.

Where does this leave us? I think there's far more that you and I agree upon than we disagree.

Best,
Pam


Pamela A. Warren, Ph.D.


From: "Douglas W Martin" < Douglas.Martin@... >
To: main@ACOEM-WFDSection.groups.io
Sent: Thursday, April 21, 2016 9:13:28 AM

Subject: Re: [ACOEM-WFDSection] Psychosocial issues - their place in WC



Thanks for your detailed response. I support your position and am fortunate to have learned much regarding psychological issues from my AADEP colleague Bob Barth who has taught with me at AADEP courses for many years. He is exemplary when it comes to providing literature support and has also made many of the points that you have expressed below. I am well aware of the Daubert standard and have been through one Daubert challenge as an expert witness.



Many state WC systems however do not use the Daubert standard. Iowa is one of them, unfortunately. In Iowa, when I go and testify at an Industrial Commissioner hearing, my opinion is given the same weight as a chiropractor, naturopath, physical therapist, etc. It is incumbent upon the commissioner to try to figure out who is right, and even though I explain the literature, often the decision is counter to science. We really do have “work related fibromyalgia”. For those OCD, you can go here:



http://decisions.iowaworkforce.org/workerscomp/Pages/default.aspx



and just type in fibromyalgia in the search bar. You can then type in any number of psychological descriptors and look at those.



Click on any number of the decisions and you will see what science, medicine, and myself battle in this wonderful state.



Douglas W. Martin, MD, FAADEP, FACOEM, FAAFP

Medical Director

UnityPoint Clinic – Occupational Medicine

4230 War Eagle Drive

Sioux City, IA 51109



712-224-4300

712-224-4302 (fax)



Past President – American Academy of Disability Evaluating Physicians

Past President – Iowa Academy of Family Physicians



From: Pamela A Warren [mailto: pawarren@... ]
Sent: Wednesday, April 20, 2016 8:42 PM
To: main@ACOEM-WFDSection.groups.io
Subject: Re: [ACOEM-WFDSection] Psychosocial issues - their place in WC




Doug,


Ah, I see the point you're making. From my professional vantage point, it really is that psychosocial issues are never compensable. That's what I write in my reports. For my discussion below, let's clearly separate psychosocial issues from psychological conditions. Psychosocial issues cannot be objectively found to cause injury because they are perceptions/beliefs/preferences. Psychological conditions may be found to caused a psychological injury.





Here's why, psychosocial issues lack diagnostic criteria. How does a professional demonstrate the existence of a psychosocial issue if it cannot be diagnosed? The diagnostic criteria are critical since these detail the types of impairment in functioning that the individual with a valid condition is likely to experience. A valid psychological condition has diagnostic criteria that note the parameters of that condition. Psychosocial issues do not. Psychosocial issues vary across individuals. Since this is the case, it is an uphill battle for an attorney to attempt to assert injury for something that isn't recognized as a valid condition by the pertinent scientific community. Think Daubert standard. Daubert standard requires that professional testimony and evidence must demonstrate: a) reliability and include data objective and reliable and not merely a subjective opinion. In addition, any methodology or treatment must be peer-reviewed. Any testimony and treatment with potential rate of error and standards are known and controlled. There are standards and conditions under which methodology is conducted. Final requirement: there must be general consensus of the scientific community in regards to treatment and methodology utilized.





Consequently, an attorney may try to build the case for causation and will. However, for causation to be demonstrated in the case of psychosocial issues, the attorney must demonstrate that a preponderance of evidence makes the reported impairment more likely than not to have occurred. This is the But-for test. Since psychosocial issues are subjective opinion, do not result in impairment in functioning and are not objective in nature, that means the attorney is putting forth a lot of effort to argue that a perception/subjective opinion is the purported injury. Would this stand up to the Daubert standard or a challenge. No. There isn't a way to reliably measure a psychosocial issue that produces objective data that is indicative of psychological injury and/or impairment in functioning. It is merely subjective opinion. There is no standard of care to treat subjective opinion as a stand-alone condition. We do have ways to objective document the existence of psychosocial issues in WC/STD/LTD claims. There is general consensus that psychosocial issues are not injuries or valid conditions, but do influence treatment outcomes. This would mean that the But-for test could not be met.








Instead, it is far easier for the attorney to argue proximate cause. However, many States, such as FL and others have recently introduced the Daubert standard (by law) into the WC treatment and disability claims process. Thus, it is no longer sufficient to merely demonstrate cause-in-fact or proximate cause to a purported event. Instead, causation testimony and evidence in those States must now also meet the Daubert standard. This type of inclusion of current scientific consensus and methodology raises the bar to conclusively prove causation. Moreover in WC, causation can be a moot point if the State (such as Montana) doesn't recognize mental-mental claims. Thus, in Montana neither psychosocial issues or psychological conditions can be WC injuries.





I just finished writing an article on psychological injury in WC (State and Federal) that will be published in the upcoming Special Work Comp Issue of the Psychological Injury and Law journal. Here are a couple of paragraphs from that article illustrating some of the points that I'm noting:





An example of a State which allows a mental-mental claim, with certain qualifying factors is Tennessee (TN). In order for a mental-mental claim to be considered within the TN Workers' Compensation system, there two conditions that must be met . First, the psychological injury must stem from an identifiable stressful, work-related situation that produces a sudden mental effect, such as shock, fright, or excessive anxiety. Second, the event must be extraordinary in comparison to the stress that is typically experienced by an employee in the same type of duty. Thus, not all purported mental-mental TN WC claims are approved. Recently, the Tennessee Special Workers’ Compensation Appeals Panel affirmed a trial court’s denial of registered nurse'c WC claim who worked in a variety of psychiatric treatment units since 1986. The employee claimed psychological injuries of Major Depressive Disorder and Post Traumatic Stress Disorder (PTSD) caused by workplace stress. The Special WC Appeals Panel found that the evidence did not support that the employee was exposed to an unusual amount of work stress and that his purported injuries were not abnormal, extraordinary, or unusual when viewed under the objective standard (Ireton v. Horizon Mental Health Mgmt., LLC, 2016 Tenn.).



In regards to psychological injury, the State of Florida (FL) does not allow mental-mental claims. Instead, any mental health condition that is said to arise from the workplace must have occurred related to physical workplace injury only. Moreover, in the past two years, in regards to WC claims, FL has introduced Daubert into its WC laws. Thus, if a workplace psychological injury is said to occur, then, the assessment and treatment of the psychological injury must meet the Daubert standard that was discussed earlier. By taking this stance, FL requires any purported psychological impairment to have been assessed meeting current standards of care, regarding the evaluation, treatment, and assessment of a reported psychological condition, such as the American Psychological Association's Testing standards. Moreover, by using Daubert standard, the State of Florida has greatly narrowed the window of the physical-mental claims being allowed because they must be objectively determined to exist and that any psychological injury must be periodically be re-assessed through the life of the claim. If the claimant attempted to argue permanent psychological injury related to a physical workplace injury, then, this stand may backfire since the psychological injury would improve both in receiving empirically-supported psychological and psychiatric treatment and also, once the individual is out of the workplace. Importantly, the majority of psychological conditions are not permanent in nature, this would mean that the likelihood of a permanent psychological injury claim being approved to be greatly reduced.





Another example that just recently occurred when a WC claim in which the employee claimed psychological injury when his supervisor was reported to have made derogatory comments about the employee. The State held that there was no psychological injury. Instead, it was the employee's perception of injury which was the impetus of the filing of the claim. There a preponderance of evidence that did not support the claim. Thus, it was denied.





So, although I stated my opinion more concisely in my earlier email, I wanted to explain what I mean in more detail with this email.





Thanks,


Pam





Pamela A. Warren, Ph.D.






From: "Douglas W Martin" < Douglas.Martin@... >
To: main@ACOEM-WFDSection.groups.io
Sent: Wednesday, April 20, 2016 7:15:04 AM
Subject: Re: [ACOEM-WFDSection] Psychosocial issues - their place in WC





Agree with everything in that psychosocial issues are at the core of the development of the SPICE Model whose purpose is to prevent iatrogenic disability.



I would point out one item, Pam……I think you mean that “Psychosocial issues SHOULD never be compensable”. I have long since learned that there is a huge difference in the workers compensation world between compensability and causation. Thus, for example in Iowa, we have “work related fibromyalgia”, “work caused DJD of bilateral weight bearing joints”, etc. Of course, science is clear that these do not exist and should not be compensable, but the reality is that legal trumps medical and we then have to “deal with it”. Also, it has been my experience that many claims examiners will “authorize” evaluation and even treatment for psychosocial problems without giving a thought to causation analysis.



Thanks.



Douglas W. Martin, MD, FAADEP, FACOEM, FAAFP

Medical Director

UnityPoint Clinic – Occupational Medicine

4230 War Eagle Drive

Sioux City, IA 51109



712-224-4300

712-224-4302 (fax)



Past President – American Academy of Disability Evaluating Physicians

Past President – Iowa Academy of Family Physicians



[Moderator note - in response to:]



"...You're right. Psychosocial issues are never compensable. These issues are quirks, perceptions, and preferences. Psychosocial issues aren't valid psychological conditions. Yet, they're right there, front and center in both the treatment process and disability process...











Pam"

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locked Re: Choose Font

Jean Bennett
 

Mark:

Thank you so very much for your prompt response to our request.  Our members are just in awe and so very grateful for your willingness to entertain our requests and, more importantly, to implement them.  We are so happy we switched to Groups.io.

Jean


locked Re: Message Search Problems?

 

Leanne, I second what you said to Mark. I am beyond pleased with groups.io

Meanwhile, I would be interested to join your equine group. Where would I find it?


Rae
--------------------------------------
Rachel Rice (Rae the Indexer)
Freelance Indexer
rachelrice.com


locked Re: Rejection emails not being sent?

Linda
 

Hi Mark,
You wrote:
 
Much to my surprise (and oversight), we apparently have never sent rejection notices when you reject a pending message via email. We do now.
 
I assume a rejection notice will not be sent when a pending Integration is rejected...
 
Thanks,
Linda


locked Selecting next message to read - order of display is reversed?

John P
 

I usually look at messages in Message View (as opposed to thread view) with newest message first, and then select a message of interest and read it. Doing that puts me in Single Message View.

All good so far.

To advance to the next message, I think click on the right arrow at top right of screen, but doing that now takes me to the previous message not the next message.

Just to be clear.....right arrow takes me to the previous message and left arrow takes me to the next message.

I think this is back to front isn't it?

Thanks,

John P





locked Re: yay the top posters is gone

vickie <vickie_00@...>
 

 Finally  gone
This is the first thing I mentioned  months ago. 

Thank you Mark
Vickie

 









From: Rachel Rice <rae.the.indexer@...>
To: beta@groups.io
Sent: Tuesday, April 26, 2016 7:01 AM
Subject: [beta] yay the top posters is gone

Thank you!!!!

Rae
--------------------------------------
Rachel Rice (Rae the Indexer)
Freelance Indexer
rachelrice.com









locked Re: Choose Font

 

Hi Jean,

On Sat, Apr 23, 2016 at 4:12 AM, Jean Bennett via Groups.io <jcbennett@...> wrote:

Our members have requested the ability to choose a font when composing messages from the board.  Is this a planned feature?  If not, could it be added to the list?

I've added the ability to select the font when composing a message.

Cheers,
Mark 


locked Updates to Trello

Beta Integration <beta@...>
 


locked Re: Rejection emails not being sent?

 

Hi James,

On Sat, Apr 23, 2016 at 9:06 AM, James Homuth <james@...> wrote:
So I've had to reject a couple messages from folks on moderation. I do it via email usually simply because I happen to be there anyway when I do it. I just got an email from one of those people saying they haven't seen their posts or anything else saying there was an issue. Are rejection emails no longer being sent?

Much to my surprise (and oversight), we apparently have never sent rejection notices when you reject a pending message via email. We do now.

 
Additiionally, is it possible to specify a reason in the rejection message when you do it by email?
_
That will be trickier to do. I've added it to the TODO list.

Thanks,
Mark


locked Re: Search

 

Mark,

It's fixed. Thanks.:-)

I've noticed that a search using threads view now returns only threads that have the term in the thread title. I'm not sure what the pros and cons of this are. I'm not used to it, but I suppose you can always do the search in message view if you want all messages.

However, if there's any choice here, I would return the same results in both views. (Maybe you could instead just add a weighted term for "contained in thread title" for calculating relevance?)

--

J


locked Re: Search

 

Hi John,

On Tue, Apr 26, 2016 at 11:33 AM, JohnF via Groups.io <johnf1686@...> wrote:
On Mon, Apr 25, 2016 at 05:16 pm, Mark Fletcher <markf@corp.groups.io> wrote:
> Now when entering a message number, it'll stay on Message or Expanded
> Message View. If you were viewing the results of a search, the search is
> cleared. The sort order (ascending or descending) is kept the same.

It's better now, though entering a message number seems to always go to Message View if I was in Expanded Message View.  However, switching back to Expanded Message View stays on the same number, so it's just one extra step.

This should be fixed now.

Thanks,
Mark 


locked Re: Search

 

Hi J,

On Tue, Apr 26, 2016 at 7:50 AM, J_catlady <j.olivia.catlady@...> wrote:

And speaking of griping: ever since I did a test search and then clicked on "date" to reorder the search results by date, chrono order (oldest displayed first) has turned into the *permanent* default for viewing messages. I have changed it back several times to reverse chrono order by toggling the "date" button, but now, every time I go into my group and switch from thread view to message view, I have to do it again.

This should be fixed now.

Thanks,
Mark 


locked Re: Search

 

On Mon, Apr 25, 2016 at 05:16 pm, Mark Fletcher <markf@corp.groups.io> wrote:
Now when entering a message number, it'll stay on Message or Expanded
Message View. If you were viewing the results of a search, the search is
cleared. The sort order (ascending or descending) is kept the same.
It's better now, though entering a message number seems to always go to Message View if I was in Expanded Message View. However, switching back to Expanded Message View stays on the same number, so it's just one extra step.

In single message view, the next and previous arrows use the sort order
from the Messages page that you came from. So if you were viewing from
newest to oldest, the next arrow will go back in time, and vice versa. This
is so you can go through search results one message at a time. I can
understand how it would be confusing, and I'm not sure how to make it
better.
If it were me, I'd want them to always go to the real Next or Previous message regardless of the sort order. However, I understand others are more used to it reacting based on sort order, so I'll just adapt to whatever it ends up as.

By the way, the visited link color changes are no longer useful. I think it's because of an "offset" added to the URL. They change color for a while, but as soon as someone posts something new, the offsets all change, so they aren't the same links anymore. Something I read yesterday won't be colored as having been read anymore.

Thanks,

JohnF


locked Photos question

weebeequilting <weebee.1@...>
 

Is there a way to identify who posted a photo to a photo album?  The only thing showing is the number assigned by their camera or photo viewing software--no name.  The photo is in an album anyone can add to.


Janice B

AZ


locked Re: Search

 

And speaking of griping: ever since I did a test search and then clicked on "date" to reorder the search results by date, chrono order (oldest displayed first) has turned into the *permanent* default for viewing messages. I have changed it back several times to reverse chrono order by toggling the "date" button, but now, every time I go into my group and switch from thread view to message view, I have to do it again.

Mark, I can contact you offlist if you prefer, but this happened coincidentally with the "relevance" feature so I think it's connected to that (and maybe some inadvertent small bug).
--

J


locked Re: Message Search Problems?

 

Likewise, Mark's work is helping to save many feline lives. If I am vocal in asking for improvements and wish list items (I cop to that - it's so much fun, especially since Mark is so responsive!), I should be at least 10 times as vocal in expressing my appreciation and thanks - which I hereby do :-)
J
Sent from my iPhone

On Apr 26, 2016, at 6:18 AM, LeeAnne Bloye <ecir.archives@...> wrote:

[Edited Message Follows]
[Reason: forgot signature!]

Thank you Mark for looking into this and making Groups.io. Your dedication to improving groups.io goes farther than just helping your mods and owners.  With our group, your work provides the tools of communication needed for horse owners learn how to prevent pain and early death for their horses.  There are certainly many more groups here, using your tools  for gaining knowledge and improving situations.  

If only the entire internet would take a page from your book...

-LeeAnne

ECIR Archivist


locked Re: Message Search Problems?

Shadow Grafix <shadowgrafix@...>
 

Yep, one page should just about do it.

Judy

 

 

From: LeeAnne Bloye [mailto:ecir.archives@...]
Sent: Tuesday, April 26, 2016 9:19 AM
To: beta@groups.io
Subject: Re: [beta] Message Search Problems?

 

Thank you Mark for looking into this and making Groups.io. Your dedication to improving groups.io goes farther than just helping your mods and owners.  With our group, your work provides the tools of communication needed for horse owners learn how to prevent pain and early death for their horses.  There are certainly many more groups here, using your tools  for gaining knowledge and improving situations.  

If only the entire internet would take a page from your book...