Early psychosocial screening involves using structured, user-friendly questionnaires to identify workers at risk of prolonged recovery due to psychosocial factors. The screening should ideally be conducted in the first 2 weeks after an injury to identify individuals who may benefit from early targeted support.

Choosing a screening tool

Several validated screening tools are available, with the Örebro Musculoskeletal Pain Screening Questionnaire Short Form (ÖMPSQ-SF) considered to be the gold standard. This 10-item questionnaire assesses pain, fear avoidance, mood and work expectations.

Other options include:

•the AB-5 tool: A brief, 5-question assessment of function, emotions, coping, confidence and work perceptions

•the STarT Back Screening Tool: Specifically designed for low back pain

•the Yellow Flag Questionnaire: A conversational tool to identify barriers

When selecting a screening tool, consider factors such as:

•Ease of use and administration

•Validity and reliability in predicting outcomes

•Applicability to your workplace context and types of injuries

Implementing the screening process

To implement psychosocial screening effectively:

•determine when screening will occur (for example, within 3 to 5 days of the injury being reported)

•decide on the delivery method (for example, an online survey or phone interview)

•establish clear protocols for administering the screening tool

•train staff on how to introduce and conduct the screening

•set up a system for scoring and interpreting results

•develop a referral pathway for workers who are identified as high-risk.

While initial screening is valuable for identifying workers at risk, a more comprehensive psychosocial assessment is crucial for those identified as having elevated risk. This in-depth assessment goes beyond the initial triage to explore the specific issues affecting that individual's ability to recover and return to work.

Psychosocial assessments should be conducted by trained professionals who use a 2-pronged approach:

•administering self-report questionnaires, and

•following up with an in-depth discussion about the results.

This combination of objective data and personalised dialogue allows for a nuanced understanding of the unique psychosocial landscape impacting the individual's recovery and RTW process.

What a comprehensive assessment covers

A comprehensive assessment typically covers multiple domains, including:

•pain intensity and interference

•emotional distress

•coping strategies

•confidence in returning to work, and

•perceptions about the workplace.

These tools can provide valuable insights into these areas

•The Depression, Anxiety, Stress Scale (DASS-21)

•Brief Pain Inventory (BPI)

•Pain Self-Efficacy Questionnaire (PSEQ), and

•Fear-Avoidance Beliefs Questionnaire (FABQ).

The results of this assessment guide the development of a tailored intervention plan, ensuring that the support provided directly addresses the individual's specific psychosocial barriers.

Matched care involves tailoring interventions to address the specific psychosocial barriers that were identified through screening and assessment. This approach typically includes 3 key elements:

•Individual psychosocial counselling

•Extra workplace support

•Extra healthcare support

Psychosocial counselling

Psychosocial counselling helps workers address barriers such as:

•fear of re-injury

•low confidence in the ability to return to work

•poor coping strategies

•workplace relationship issues

Counselling should be provided by trained professionals who can use evidence-based techniques to help workers develop effective coping strategies and build confidence in their ability to return to work. Up to 6 sessions are typically provided and the average use to date has been 5.

Workplace support

RTW coordinators play a crucial role in providing workplace support. Their responsibilities may include:

•meeting with the injured worker early in the process to discuss workplace barriers

•communicating with the psychosocial counsellor to identify areas where they can help facilitate an early RTW

•engaging in open communication with the worker's treating doctor and supervisor to address any obstacles to RTW

•providing education and ongoing support for the worker's supervisor.

Healthcare support

Extra healthcare support aims to ensure that healthcare practitioners understand the overall scenario and avoid treatments that may exacerbate unhelpful beliefs and behaviours. This may involve:

•using Injury Management Consultants (IMCs) to reassure both the worker and the treating doctor about the safety of returning to work

•conducting case conferences with the treating doctor to agree about the worker's condition, progress and RTW plan.