Assessment needs to include a comprehensive history and clinical assessment targeting all three key dimensions:

• Pain – behavioural and functional issues:
  intensity, quality, emotional component of pain, pain-related fear, pain-related fear avoidance behaviour, catastrophising.
• Psychopathology/clinical assessment (eg, anxiety or depression).
• Occupational/industrial/compensation issues:
  workplace issues, interpersonal issues, work-related fears, safety fears, disputes regarding income maintenance, misperceptions regarding claim or expectations of the workers compensation system.

It is important to integrate available information about biomedical issues eg, current treatment direction or barriers to treatment.

Assessment should utilise appropriate and well-validated instruments and procedures relevant to problem areas and goals of treatment.

As part of this phase, it is important to:

• encourage self-efficacy
• assess and manage motivation to engage in treatment
• assist the worker in acquiring coping skills
• assist the worker with their physical treatment and return to function and normal activities with graded activities
• complete a comprehensive psychosocial/psychological assessment
• treat distress/anxiety or potential psychosocial barriers
• undertake intervention to manage potential interpersonal or workplace issues or other barriers
• implement changes to the worker’s environment where appropriate
• focus on goal setting where possible
• apply treatment methods which are evidence-based in clinical psychology
• communicate with the treating medical practitioner
• ensure that professional involvement includes the worker and their functioning in their psychosocial environment (ie, family, habits, additional life stressors, the relationship to their employer and WorkCover)
• ensure all interventions are conducted in cooperation with the worker’s physical treatment providers
• consider contact with the workplace, where appropriate
• consider intercession and education of key workplace parties if appropriate
• consider review of need for additional advice and or management if there are significant psychiatric issues (ie, referral to psychiatrist)
• always maintain confidentiality

• While it is not possible to specify the exact number of sessions required to complete treatment, there is an expectation that the psychologist will monitor progress and review treatment plans.
• There should be ongoing evaluation of treatment progress against identified goals.
• A formal review of the treatment should be undertaken after six sessions.
• Treatment needs to be modified or ceased depending on results of the review.
• Ongoing communication with the treating medical practitioner and relevant parties including the claims manager and rehabilitation consultant, where appropriate, is helpful when extended treatment is required.

Note: All services must be billed in line with the WorkCover Psychology fee schedule and guidelines.

If there is a delay in improvement conduct a full review, allow for a longer consultation time and:

• review the diagnosis
• review treatment objectives
• review the effectiveness of therapies and treatment and ensure treatment is clinically justified
• review red and yellow flags
• gauge the worker’s perspective
• contact other parties involved in the management of the worker
• consider arranging a case conference, workplace visit or workplace assessment
• if necessary, refer the worker to a medical specialist or psychologist
• continue to promote self-management techniques
• identify activity issues and problems
• set defined goals for the next few weeks
• consider the need for engaging a workplace rehabilitation provider
• update the management plan.

If progress has not met expectations at 12 weeks, consider the following:

• Do you have the correct diagnosis?
• Do you have the correct treatment?
• Do you require a second or specialist opinion?
• Is there an issue in the workplace not previously identified or resolved?
• stepping up the approach to care
• multi-factorial and interdisciplinary intervention – consider meeting all relevant health providers, the worker, the employer and case manager in a case conference
• a structured, supervised, active treatment program
• a structured return to work program, focused on a gradual increase in duties
• a referral for workplace rehabilitation (if not already underway).