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Psychological conditions with severe symptoms can result in considerable impairment in functioning, and psychological disability claims, also called behavioral health disability, have increased during the past two decades. A review of states’ workers’ compensation (WC) systems shows no overlap between systems; that is, all states and federal WC systems have unique terminology, rules, and laws. In order to thoroughly evaluate the individual, evaluators must use a biopsychosocial approach that combines aspects of biological, psychological, and psychosocial issues. Studies consistently demonstrate a high degree of comorbidity between physical and psychological conditions, but frequently only the former are identified and treated. Current disability systems use byzantine definitions of disability and require professional opinions and documentation that do not comport with current psychological standards of care, introducing imprecision. Many issues relating to WC terminology and laws can be addressed if the Daubert standard is incorporated into any amendment of WC state and federal laws. The Daubert standard requires that currently accepted scientific methods be used when a professional offers testimony as an expert or is submitting professional treatment records (eg, in a WC determination). Compliance with the Daubert standard requires more consistent, objective professional documentation and testimony to ensure even-handed decisions that align with standards of psychological care. One observer has suggested that the Daubert standard is a mechanism by which junk science is kept out of legal proceedings.

Psychological injuries, like physical injuries, may occur within the workplace. If those injuries are reported to be a result of a triggering event in the workplace, then a workers’ compensation (WC) claim may be filed by the individual. State WC and the federal WC systems have laws and rules in place to address workplace psychological injury claims. However, because each State has its own WC State laws as does the federal WC system, there is no current standardization in defining either psychological injury or in defining disability. This is because each system has its own definitions. A few States allow workplace psychological injury claims. Some States do not accept WC psychological injury claims. The remaining States recognize workplace psychological injuries but with specific limitations. The federal WC system allows WC psychological injury claims. There are problematic issues that occur in the State and federal WC systems. These issues are utilizing outdated terminology, employing outdated diagnostic criteria, and allowing documentation submission and professional opinion that does not comport with current professional standards of care. In addition, the need for a definitive answer to address causation is not always possible to address with regard to psychological injury. These types of issues introduce imprecision into the determination of psychological injuries. To address these concerns, the American Medical Association developed the Guides to the Evaluation of Permanent Impairment as a means to take a more scientific approach to the assessment of impairment. This stance was a move away from the poorly defined term, “disability”. The focus was on evaluating the individual’s functioning in terms of impairment. The AMA holds that this is a more objective method that provides a balance between clinical opinion and the utilization of a more scientific methodology that increased precision in the determination of psychological injury and purported impairment in functioning that may have resulted from the injury. The American Medical Association’s Guides to the Evaluation of Permanent Impairment are utilized by many States and the federal WC systems to assist in the evaluation of psychological impairment in functioning and in the WC claims process. Some States opt to use earlier editions of the Guides. Other States and the federal WC system require the usage of the most current edition of the Guides. A few States opt to forego the usage of the Guides altogether and develop State-specific guidelines. The complexities that arise within the WC systems as well as usage of the Guides to evaluate and assess psychological injury are explored as well as potential solutions to address the imprecision that occurs within the WC systems.

A snapshot of the behavioral health (BH) spectrum reveals numerous factors that dramatically impede favorable treatment and disability leave outcomes. The managed care system was originally developed as a means to have the primary care physician (PCP) manage an individual’s health concerns. However, an unintended result has been that PCPs have become the primary professionals who are treating BH concerns. Thus, the primary care system has become the de facto mental health system in this country. Moreover, the additional aspects of poor diagnostic processes, treatment follow-up, and referrals to BH professionals further compound the poor treatment outcome issue. Additionally, the impact that insurers and the federal disability program, Social Security Administration, of both lengthy approval processes for needed services and the lack of incentives to facilitate the individual’s return to work have resulted in a problematic issue of great complexity.

Disability has traditionally been defined in biomedical terms and closely associated with objective physical impairment. More recent conceptualizations though, hold that a comprehensive evaluation of disability requires not only the assessment of objective physical impairment, but also an assessment of the psychosocial context in which the disability occurs. Some psychosocial risk factors, such as socioeconomic status, are objective in nature. In contrast, other psychosocial risk factors, such as depression, are determined by the report of subjective states. To assess these subjective states, standardized psychological tests can play a valuable role. The defining characteristics of standardized psychological tests are discussed, as are their uses. Commonly used psychological tests are reviewed. Practical questions are also addressed, such as when to administer psychological tests, what psychosocial risk factors need to be assessed, what tests to use, methods of quantifying the level of psychosocial risk, and the detection of faking.

This chapter explores the breadth of behavioral health (BH) concerns in greater detail. While there has been an increasing trend of BH disability claims, there are also multiple issues that occur within the treatment and management systems that serve to prolong them. Moreover, because there is a lack of standardization in identifying and treating BH concerns, each professional plays a role in the current iatrogenic disability process. These primary issues that occur within the BH disability management process will be discussed further in order for a consumer of clinical services to be of these potential pitfalls that lead to iatrogenic BH disability.

There several ways that iatrogenic BH disability can occur through actions of (1) the individual, (2) TPs, (3) employers, (4) attorneys, and (5) insurers. The contributions and nuances of each and how these multiple factors can lead to iatrogenic BH disability will be examined further.

There are multiple factors that impede the implementation of standards into the behavioral health (BH) treatment and disability processes. The combination of physical and psychological conditions as well as the influence of psychosocial issues has consistently been identified as having negative effects on treatment and treatment outcomes. Further, the wide-spread lack of standardization causes a multitude of problems throughout both BH processes. The focus of this first article in a three-part series will examine the explosion of behavioral health claims and the major factors, such as comorbid physical conditions and psychosocial issues, associated with these types of claims. In addition, the overarching theme of lack of standardization will begin to be explored in regard to the problematic definition of disability, communication difficulties between treating professionals and disability insurers and agencies as well as the introduction of bias into the BH treatment and disability processes.

The impact of scientific findings on medical, psychological, and legal concepts has led to the adoption of laws and regulations that do not easily fit into the established legal categories of medical law or mental health law. Instead, this convergence of forces has resulted in laws and regulations mandating biopsychosocial treatment guidelines, where both medical and psychological cares are integrated within the framework of a single paradigm. Laws and regulations of this type have been adopted by a number of US states and Canadian provinces, and could be considered to represent a new category, for which we offer the term “biopsychosocial law.” Biopsychosocial laws currently pertain to medical treatment guidelines for workers’ compensation, a medical treatment system noted for high costs, high levels of litigation, and psychological involvement. There are a number of examples of biopsychosocial laws, but the most noteworthy are based on guidelines developed by the Colorado Division of Workers’ Compensation, the American College of Occupational and Environmental Medicine, the Work Loss Data Institute, and The Reed Group. These guidelines differ significantly with regard to features, conditions covered, and strength of evidence basis. However, all of these guideline systems were developed with the intent of providing good care while controlling costs, are evidence based, integrate the practice of medicine and psychology, and are legally mandated in certain jurisdictions. Taken together, these guidelines represent a growing convergence of scientific evidence, professional society positions, payor policies, and legal regulations. These forces are propelling a broad societal shift away from Cartesian assumptions that the body and mind are separate, and toward a biopsychosocial paradigm for the treatment of injury and illness.

This Special Issue of Psychological Injury and Law focuses on the complexities of the return-to-work (RTW) process in the disability compensation context. Although the goal of RTW is to facilitate an individual's return to and active involvement in the workplace, stakeholders are also involved in this process, aside from the affected worker and the treating professional. A continual interaction exists among the individual, treating professional(s), employer, case manager, vocational rehabilitation professional, physical and occupational therapists, insurer, health-care system, and in some instances, the attorneys. In addition, state and federal laws impact the process. In this issue, some of the problems that arise in RTW and the system complexity involved will be discussed in depth. Overall, the multiple and interactive influences on RTW can be conceptualized as the macrosystem (economic environment, societal attitudes, law, public policy, health care, rehabilitation and compensation contexts andmodels),mesosystem (employer characteristics and work organization), and microsystem (the individuals with disability claims and their unique sociodemographic, clinical, occupational, and psychosocial characteristics). The challenge of improving RTW outcomes is creating a seamless interaction between the micro-, meso-, and macrosystems; this applies, especially for individuals with non-visible disabilities, such asmental health issues, chronic pain, and those in the recovery course with psychosocial, medicolegal, economic, and/or employment factors creating complications. (Schultz et al. 2007). Disability is a contextualization of impairment and is best alleviated not only by individual changes and the affects of environment and context, but also by broad systemic understanding and change. A consistent accumulation of evidence shows that disability and poor RTWoutcomes among compensated individuals are perpetuated more by an array of psychosocial and system-related factors than by the medical factors possibly associated with the original injury or illness. However, some of these psychosocial and system-related factors are modifiable and some are not (White et al. 2013); those modifiable tend to be similar across various diagnoses and conditions that are prevalent in compensation systems. Thus, they lend themselves to risk identification, focused targeting in prevention, early intervention, and rehabilitation, as well as development of standards and guidelines for involved health professionals and stakeholders. This Return-to-Work Issue of Psychological Injury and Law examines the advances in the conceptualization, research, and practice related to improving outcomes in RTW among individuals with a complicated course of recovery. The Special Issue balances two themes: the challenge of intervention with individuals at an elevated risk for disability aimed to facilitate RTW with the challenge of systemic factors impacting the RTW workplace, especially preparation, training, and standards of professionals and services facilitating RTWand a wide range of other system factors. The papers in the issue also deal extensively with complicating and confounding factors in RTW. Three of the papers, authored by Dr. Warren (consisting of three consecutive parts), Dr. Caruso, and Dr. Couser, deal with challenges related to preventable disability. In particular, issues of behavioral health and addictions, articulated from an integrative biopsychosocial perspective, provide conceptual, empirical, and professional insights The authors contributed equally to this introduction.

Most cancer registrars work with cancer committees and are challenged by the many struggles associated with maintaining compliance with the Commission on Cancer standards regarding attendance and participation. Facilitymandated participation may improve the attendance of those participants who are employed by the facility, but even then, fully engaged involvement often remains elusive. Ironically, it is often the cancer registrar who is held responsible for finding ways to keep the cancer committee engaged. Viewing and respecting cancer committee members as volunteers offers the cancer registrar a unique opportunity to utilize the tools of volunteer management to meet these challenges. Several techniques were taken from experts in the field of volunteer management and adapted for use with cancer committees.

Purpose A noteworthy attempt at health care reform was the 1992 Colorado workers' compensation reform bill, which led to the creation of what has been called "biopsychosocial laws." These laws mandated the use of treatment guidelines for patients with injury or chronic pain, which advocated a biopsychosocial model of rehabilitation, and aspired to use a "best practice" approach to controlling costs. The purpose of this study was to examine the financial impact of this health care reform process, and to test the hypothesis that this approach can be an effective strategy to contain costs while providing good care. Research method This study utilized a dataset collected prospectively from 1992 to 2007 in 45 U.S. states for regulatory purposes. These data summarized the medical treatment and disability costs of 520,314 injured workers in Colorado, and an estimated 28.6 million injured workers nationally. As no other state passed a comparable bill, the Colorado worker compensation reform bill created a natural experiment, where a treatment group was created by legally enforceable medical treatment guidelines. Results In the 15 years following the implementation of the reform, the inflation of medical costs in Colorado workers' compensation was only one third that of the national average, saving an estimated $859 million on patients injured in 2007 alone. Conclusions Although there were confounding variables, and causality could not be determined, these data are consistent with the hypothesis that Colorado's 1992 legislative efforts to reform workers compensation law using the biopsychosocial model worked as intended to provide good care while controlling costs.

Behavioral health disability , Behavioral health disability , کتابخانه دیجیتال جندی شاپور اهواز

This chapter explores the breadth of behavioral health (BH) concerns in greater detail. While there has been an increasing trend of BH disability claims, there are also multiple issues that occur within the treatment and management systems that serve to prolong them. Moreover, because there is a lack of standardization in identifying and treating BH concerns, each professional plays a role in the current iatrogenic disability process. These primary issues that occur within the BH disability management process will be discussed further in order for a consumer of clinical services to be of these potential pitfalls that lead to iatrogenic BH disability.

This chapter discusses the common components in the current Behavioral Health evaluation process. These basic components should be the same regardless of the type of BH professional completing the examination process and whether the BH professional is in the treating or forensic role. However, there are additional factors that must also be explored by the BH evaluator in order to complete a comprehensive evaluation that assesses the psychosocial aspects that may greatly impede the treatment, stay-at-work, and return-to-work processes. Unfortunately, these aspects are not regularly addressed by all BH evaluators and so, may serve as yellow flags regarding the depth of the completed process. The primary rationale for completing these additional components is that they serve to answer the question regarding the individual’s current level of functioning. By examining the person from a biopsychosocial stance, answers regarding the person’s ability to function in a variety of settings including work can be addressed.

Too little attention has been given to the manner in which drought detection and monitoring indices are applied in agricultural settings. In this research, results of an Illinois corn-weather sensitivity analysis were used to select values of the moisture anomaly index (MAI or z) and related Palmer drought severity index (PDSI or X) to match periods of maximum moisture (i.e., drought) sensitivity in the corn growing season. These partial growing season values were compared with their equivalent growing season average for 12 Illinois sites to evaluate which were most effective in explaining interannual variations in detrended corn yields. Results indicate that the Palmer indices calculated for only the peak corn moisture sensitivity periods, outperformed the mean growing season Palmer indices in accounting for 1960–1983 interannual variations in corn yields by a factor of more than two.

Summary When young stems are wounded or grafted so that the cambium is interrupted, new vascular cambia tend to regenerate in the callus proliferating from the wounded surfaces. The position in which such cambia arise varies according to the type of wound, but usually is such as to restore locally the normal condition of a closed cambial cylinder. Two theories have hitherto been proposed to define how the positions of these regenerating cambia are controlled. This paper presents evidence that neither of these theories is valid in all situations, and proposes a new working hypothesis. This ‘gradient induction’ hypothesis is stated at the end of the paper. It is in agreement with all types of wound and graft so far studied, and seems also to extend to cambium formation in tissue culture and perhaps to procambium formation in normal apices.

This study of the positions in which cambia regenerate in grafts between petioles and stems aims at discovering whether principles of cambial regeneration proposed for organs with radial symmetry are applicable also to dorsiventral petioles.